Current opinion in anaesthesiology
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Initial studies suggested that the use of processed electroencephalogram technology could significantly decrease the incidence of unintended intraoperative awareness events during general anesthesia. Subsequent work has cast doubts on these findings. This review will examine the current state of awareness monitoring. ⋯ Although awareness monitors such as the bispectral index monitor may have benefit in patients in whom volatile anesthetic agents must be minimized - such as in hemodynamically unstable patients, or patients undergoing total intravenous anesthesia - these monitors do not appear to be useful for all patients.
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Curr Opin Anaesthesiol · Dec 2016
ReviewDay surgery regional anesthesia in children: safety and improving outcomes, do they make a difference?
The objective of this review is to provide an overview of recent developments in pediatric regional anesthesia and elucidate outcomes as it relates to patient safety and overall satisfaction. ⋯ Despite the limited number of randomized controlled trials evaluating the safety of individual regional anesthetic techniques, the growing body of data, such as presented in the Pediatric Regional Anesthesia Network database, suggests a high degree of safety in performing various regional anesthetic modalities. Modern medicine should continue to embrace the use of regional anesthesia, particularly in the ambulatory setting, to reduce perioperative pain and improve patient outcomes.
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Curr Opin Anaesthesiol · Dec 2016
ReviewEnhanced recovery after surgery, perioperative medicine, and the perioperative surgical home: current state and future implications for education and training.
The purpose of this review is to summarize the current state of perioperative medicine, including the perioperative surgical home (PSH) and enhanced recovery after surgery pathways (ERAS) as well as the educational implications of these concepts for current and future anesthesiology trainees. ⋯ There is sufficient evidence to support widespread adoption of ERAS principles, although the specifics of local implementation may vary from site to site. There is significant uncertainty as to what the PSH actually is. However, perioperative medicine is a defined specialty in medicine that overlaps significantly with anesthesiology core training and practice and will be a significant focus in future education, research, and clinical care provided by anesthesiologists.
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Mentoring is fundamentally valuable and important to students considering a path into our specialty, as well as to colleagues already in it and with ambition to advance. General principles and personal experiences are collected and described to help inform future mentors and to reinforce the value of having a mentor and the satisfaction (and work) that is associated with such a role. ⋯ Access to a mentor is an often-cited key to choosing a specialty and the success of junior colleagues and thus the entire department. Mentoring is fundamentally valuable in providing role modeling and also in protecting the mentee from the inefficiency of learning lessons the hard way.
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Curr Opin Anaesthesiol · Dec 2016
ReviewThe future of postoperative quality of recovery assessment: multidimensional, dichotomous, and directed to individualize care to patients after surgery.
Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment. ⋯ Recovery is best defined as a multidimensional dichotomous construct encompassing nociceptive, emotive, functional, and cognitive domains. Its assessment tool should provide both real-time and restrospective recovery data, thus enabling clinical and research applications, and be validated for repeat measures over a breadth of multiple clinically relevant postoperative time points.