Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2024
ReviewHow much does it cost to be fit for operation? The economics of prehabilitation.
Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs. ⋯ Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.
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Tranexamic acid is routinely used as part of the management of traumatic bleeding. The dose recommendation in trauma was extrapolated from other clinical settings and the results of pragmatic randomized trials rather than pharmaco-kinetic and -dynamic evaluations. The review addresses current evidence on dosing of tranexamic acid in traumatized patients with a focus on efficacy, safety and risk-benefit profile. ⋯ The benefit of tranexamic acid as adjuvant therapy in the management of bleeding trauma patients on mortality and transfusion requirements is clear and well documented, being most effective if given early and to patients with clinical signs of hemorrhagic shock. Recent reports suggest that in some patients presenting with a shutdown of their fibrinolytic pathway the administration of tranexamic acid could be associated with an increased risk of thromboembolic events and poor outcomes. A more personalized approach based on bedside assessment of fibrinolytic activation and pharmacokinetic-based dose regimen should be developed moving forward.
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Curr Opin Anaesthesiol · Apr 2024
ReviewBroadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again).
The landscape of healthcare is characterized by high demands and scarce human and financial resources. This calls for action in improving healthcare quality. This review shows how anaesthesiologists are the designated medical specialist to share their affinity and knowledge in quality and safety, throughout the hospital and across the care continuum. ⋯ Anaesthesiologist are early adapters of patient safety. In the last decades anaesthesia has become linked with patient safety and the quality of care. With the recent transition from peroperative to perioperative care; new opportunities are emerging, expanding our professional scope. Unfortunately, the anaesthesiologist is not often positioned in a leading role in quality of care and patient safety. After a brief rise during the COVID-19 pandemic, in which anaesthesiologists were visible in the frontline in many countries, we have unfortunately disappeared from the spotlight. This review shows numerous ideas, examples, and a framework how a leading position can be realized.
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The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. ⋯ To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.
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Curr Opin Anaesthesiol · Feb 2024
ReviewUpdate on minimally invasive cardiac surgery and enhanced recovery after surgery.
Numerous recent trials have examined the potential benefits of treating cardiac surgery patients with a minimally invasive approach. Recently, Enhanced Recovery After Surgery (ERAS) has also been applied to cardiac surgery, and specifically to minimally invasive cardiac surgery (MICS) patients. This review will explore current evidence regarding MICS, as well as the combination of MICS plus ERAS. ⋯ Minimally invasive cardiac surgery appears to provide patients with equivalent or better outcomes, faster recovery, and less surgical trauma compared to full sternotomy. The addition of ERAS phase specific perioperative protocols can help maximize the benefits of MICS.