Current opinion in anaesthesiology
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Implementation of enhanced recovery pathways have allowed migration of complex surgical procedures from inpatient setting to the outpatient setting. These programs improve patient safety and patient-reported outcomes. The present article discusses the principles of enhanced recovery pathways in adults undergoing ambulatory surgery with an aim of improving patient safety and postoperative outcomes. ⋯ Implementation of enhanced recovery pathways requires a multidisciplinary approach in which the anesthesiologist should take a lead in collaborating with surgeons and perioperative nurses. Measuring compliance with enhanced recovery pathways through an audit program is essential to evaluate success and need for protocol modification. The metrics to assess the impact of enhanced recovery pathways include complication rates, patient reported outcomes, duration of postoperative stay in the surgical facility, unplanned hospital admission rate, and 7-day and 30-day readmission rates.
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Curr Opin Anaesthesiol · Dec 2020
ReviewCurrent state of noninvasive, continuous monitoring modalities in pediatric anesthesiology.
The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. ⋯ New techniques are available to assess a child's hemodynamic and respiratory status while under anesthesia. These new monitors can be used as complementary tools together with standard monitoring in children, to further improve perioperative safety.
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Curr Opin Anaesthesiol · Dec 2020
ReviewMaternal safety: recent advances and implications for the obstetric anesthesiologist.
Recognition of the increasing maternal mortality rate in the United States has been accompanied by intense efforts to improve maternal safety. This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. ⋯ Anesthesiologists play an essential role in ensuring maternal safety. While continued intrapartum vigilance is appropriate, addressing the full spectrum of contributors to maternal mortality, including those with larger roles beyond the immediate peripartum time period, will be essential to ongoing efforts to improve maternal safety.
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Curr Opin Anaesthesiol · Dec 2020
ReviewMeasuring and monitoring perioperative patient safety: a basic approach for clinicians.
Recent research points to considerable rates of preventable perioperative patient harm and anaesthesiologists' concerns about eroding patient safety. Anaesthesia has always been at the forefront of patient safety improvement initiatives. However, factual local safety improvement requires local measurement, which may be afflicted by barriers to data collection and improvement activities. Because many of these barriers are related to mandatory reporting, the focus of this review is on measurement methods that can be used by practicing anaesthesiologists as self-improvement tools, even independently from mandatory reporting, and using basic techniques widely available in most institutions. ⋯ Considering the potential for perioperative patient safety measurements to improve patient outcomes, the absence of a generally accepted measurement standard and manifold barriers to reporting, a pragmatic approach to locally measuring patient safety appears advisable.
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This article describes the processes for identifying high-risk patients at the time of ambulatory procedure scheduling, enabling the implementation of multidisciplinary collaborative pathways for prehabilitation and optimization, allowing for risk mitigation and improvement in outcomes. This review is particularly relevant because of the current proliferation of ambulatory surgery with more complex procedures being performed on an outpatient basis on patients who may be American Society of Anesthesiologists Physical Status 3 or greater. ⋯ The focus of this article is on general principles and establishment of best practices based on current evidence and a brief description of anesthetic management of specific comorbidities. This review will provide guidance to the practicing anesthesiologist on identifying, stratifying, optimizing, and managing high-risk patients in the ambulatory setting.