Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2021
ReviewThe Do Not Resuscitate (DNR) order in the perioperative setting: practical considerations.
Addressing patients' Do Not Resuscitate (DNR) status in the perioperative setting is important for shared patient decision-making. Although the inherently resuscitative nature of anesthesia and surgery may pose an ethical quandary for clinicians tasked with caring for the patient, anesthesiologist-led efforts need to evaluate all aspects of the DNR order and operative procedures. ⋯ Efforts must be made to address the DNR order in the perioperative setting. The fundamental tenets of medical ethics, nonmaleficence, beneficence, and patient autonomy can help to guide this oftentimes challenging discussion.
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Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips. ⋯ Medical missions fulfill acute medical needs and have the opportunity to make a positive contribution to host communities by fulfilling local needs and supporting educational efforts for local providers.
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Curr Opin Anaesthesiol · Apr 2021
ReviewCOVID-19: should we consider it as a septic shock? (The treatment of COVID-19 patients in the ICU).
The severe acute respiratory syndrome coronavirus 2 associated coronavirus disease 2019 (COVID-19) illness combines a syndrome of viral replication and a host dysregulated inflammatory response. Despite sharing a similar etiology, COVID-19 patients present different patterns from asymptomatic to severely hypoxemic patients. In some patients, patterns of multiorgan failure have been observed similarly to patients with bacterial sepsis. This review aimed to analyze the currently available data on the treatment of COVID-19, specifically the most studied antiviral agents and therapies targeting the immune system including those that have been investigated in sepsis. ⋯ To date, the vast majority of the studied antiviral and immunomodulatory agents have failed to improve outcomes of patients with COVID-19 except for dexamethasone. Many other trials are currently underway with new antiviral agents and various immunomodulatory agents with potential clinical benefit for COVID-19 patients. Despite these emerging data, robust controlled clinical trials assessing patient-centered outcomes remain imperative.
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The epidemiology of sepsis and septic shock has been challenging to study for multiple reasons. These include changing diagnostic definitions, as well a high concentration of sepsis-related studies published from high-income countries (HICs), despite a large global burden. This section attempts to address the incidence of sepsis throughout the years and worldwide. ⋯ The true epidemiology of sepsis worldwide continues to be a highly debated subject, and more research is needed among low-income countries and high-risk subpopulations.
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Curr Opin Anaesthesiol · Apr 2021
ReviewProcedural episode-based cost measures: anesthesia matters.
Episode-based cost measures (EBCM) is a method of combining all services related to a defined episode of care, identified as either a procedure, acute illness or chronic disease, and providing expected cost for that episode or bundle of care. Procedural EBCM has become a major scheme for payment methodology and patient quality of care evaluation. Anesthesiologists need to know how EBCM can impact their clinical practice. ⋯ EBCM can impact the anesthesiologist's quality performance, efficiencies measures, and payment. To preserve practice viability, anesthesiologists must understand how their compensation is impacted by services ordered. Anesthesiologists will increasingly be expected to improve quality and efficiencies in EBCM.