Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2022
ReviewMedical disease and ambulatory surgery, new insights in patient selection based on medical disease.
Improvements in perioperative care contributed to enlarge the eligibility criteria for day case surgery and more and more patients with comorbidities may be concerned. However, underlying medical diseases may influence postoperative outcomes, and therefore, must be considered when selecting patients to undergo ambulatory surgery. ⋯ The underlying medical diseases should not be considered as sole criteria but they should rather be regarded as a dynamic process, which includes the surgical procedure as well as the experience and expertise of the perioperative setting.
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Curr Opin Anaesthesiol · Jun 2022
ReviewDo racial and ethnic disparities lead to the undertreatment of pain? Are there solutions?
The current review aims to empower anesthesiologists, specifically pain medicine specialists, to become leaders in ensuring equitable care. ⋯ The current article reviews disparities in both acute and chronic pain treatment for underrepresented racial and ethnic minorities in the United States. The authors examine whether implicit bias and lack of representation are a contributing factor for these disparities. Lastly, we will discuss potential solutions.
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Curr Opin Anaesthesiol · Jun 2022
ReviewIndividualized multidisciplinary analgesia to prevent persistent postsurgical pain.
Persistent postsurgical pain as outcome of surgery has reached more attention in the past years. In the first place because of related disability, long-term use of (opioid)analgesics and impact on the quality of life of individual patients. In addition, the individual and societal socio-economic burden of PPSP is high and increasing in the light of increasing numbers of surgery world-wide. ⋯ Future perioperative practice will have to focus on identifying patients at risk for PPSP before surgery and develop/offer suitable individually tailored preventive interventions.
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Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia. ⋯ Apneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions.