Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2018
ReviewRebound pain after regional anesthesia in the ambulatory patient.
Regional anesthesia is popular in ambulatory setting allowing safe and fast recovery. The problem of 'rebound pain', that is very severe pain when peripheral nerve block (PNB) wears off represents a clinically relevant problem and a cause of increased healthcare resource utilization. This review tries to make the point on a not so rare, unwanted and often neglected side effect of PNB. ⋯ Patients' report of excruciating pain and major distress when PNB wears off questions the quality of current anesthesia practice in ambulatory setting. Rebound pain unanswered questions are challenging in the area of perioperative medicine.
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The increasing number of procedures done in the ambulatory surgical setting necessitates the need for analgesic modalities that enable the management of postsurgical pain with fast onset, predictable duration of action, and minimal need for management of undesirable side-effects. ⋯ Local anesthetics, opioids, and NSAIDS are the mainstay of multimodal analgesic management, and as such, improving their efficacy in the ambulatory surgical setting remains the primary focus. However, as knowledge of the modulating pathways involved in transduction of pain increases, newer agents that utilize this knowledge are also becoming more widely available.
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Curr Opin Anaesthesiol · Dec 2018
ReviewEarly warning scores in the perioperative period: applications and clinical operating characteristics.
Early warnings scores are designed to detect clinical deterioration and promote intervention at the earliest possible moment. Although the ultimate effects on patient outcomes are unclear, early warning scores are now legally mandated in several countries. Here, we review the performance of early warning scores in surgical and perioperative populations. ⋯ Early warning scores may facilitate protocolized escalation of care for patients at risk of adverse events and can be used in surgical and postoperative patients, but high nonevent rates and practical implementation problems can restrict their usefulness.
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The prevalence of obesity continues to rise in developed countries. Increasingly, anaesthesiologists are faced with management of this cohort of patient in the ambulatory setting. This review summarizes the factors involved with such management of the obese patient as well as provision of guidance on recently accrued evidence. ⋯ Perioperative care of the obese patient is a multidisciplinary team exercise involving staff, equipment and insight into the condition. On the proviso of this insight, there is no reason why ambulatory care cannot be safely provided.