Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2021
ReviewAnaesthesia for minimally invasive cardiac procedures in the catheterization lab.
The share of cardiac procedures performed in settings involving nonoperating room anaesthesia (NORA) continues to grow rapidly, and the number of publications related to anaesthetic techniques in cardiac catheterization laboratories is substantial. We aim to summarize the most recent evidence about outcomes related to type of anaesthetic in minimally invasive cardiac procedures. ⋯ Inappropriate sedation and concurrent inadequate oxygenation are main risk factors for claims involving NORA care. Current evidence deriving from TAVR shows that monitored anaesthesia care (MAC) is associated with shorter length of stay and lower mortality.
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Medication errors remain a prominent source of medical harm in spite of over 20 years of effort in establishing standardized protocols and procedures, implementing assistive electronic technologies to identify medications and prevent administration errors and in establishing a just culture with regard to reporting events and near misses. ⋯ Specific attention must be paid to enhancement of medication safety in NORA sites to overcome additional challenges inherent in the provision of anesthesia care remote from the standard operating room setting.
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Curr Opin Anaesthesiol · Aug 2021
ReviewPreoperative optimization of patients undergoing interventional procedures: infrastructure, logistics, and evidence-based medicine.
Patients presenting for non-operating room procedures are often 'too sick' for surgery and require specific anesthesia care in remote areas with logistical and scheduling challenges. ⋯ Our review of recent literature confirms the complexity and supports the safety of providing care in non-operating room anesthesia locations. Standard preanesthesia assessments and principles apply to these areas.
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Curr Opin Anaesthesiol · Aug 2021
ReviewInhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation.
Following their use for medicinal purposes, volatile inhalational anaesthetic agents are expelled into the atmosphere where they contribute to anthropogenic climate change. We describe recent evidence examining the benefits and harms associated with their use. ⋯ There is now compelling evidence that anaesthetists, departments and hospitals should avoid desflurane completely, and limit nitrous oxide use to settings where there is no viable alternative, as their environmental harms outweigh any perceived clinical benefit. Life cycle analyses seem supportive of total intravenous and/or regional anaesthesia. There are many other areas where choices can be made by individual anaesthetists that contribute towards reducing the environmental burden of healthcare, such as prioritising the reduction of inappropriate resource use and over-treatment. However, this all requires joined up solutions where all parts of an organisation engage.