Current opinion in anaesthesiology
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Medicine is evolving. An increasing influx of medically complex patients coupled with diminishing resources set the stage for substantial challenges in providing safe, effective sedation and analgesia for children requiring medical procedures. This review will discuss the essential components of a successful sedation plan outside of the traditional operating room setting. ⋯ To meet this need, a multidisciplinary strategy is essential in training, performance of procedures outside of the operating room, and care coordination. To deliver safe, effective care, the sedationist must: perform a targeted presedation assessment; optimize the patient and family prior to sedation; tailor the induction and maintenance to the specific child's condition, needs, and procedure; safely recover the child; and provide a safe plan for postsedation care.
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Curr Opin Anaesthesiol · Mar 2016
ReviewUpdate on pharmacological management of procedural sedation for children.
The review provides an update on pharmacological techniques for procedural sedation for children outside the operating room. ⋯ Propofol and ketamine are commonly used for procedural sedation in children and the use of dexmedetomidine and nitrous oxide is increasing. Although the intravenous route remains the mainstay; intranasal drug administration is increasingly used for anxiolysis and moderate sedation.
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This article reviews the development of simulation-based training strategies to educate sedation providers. ⋯ Simulation provides an opportunity for sedation providers to develop deliberative practice, to consider rare or challenging clinical conditions, and to benefit from directed feedback, in a manner that does not put patients in harm's way.
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Curr Opin Anaesthesiol · Feb 2016
ReviewAre morbidly obese patients suitable for ambulatory surgery?
The incidence of morbid obesity continues to increase worldwide. Associated comorbidities, particularly obstructive sleep apnea, increase the perioperative morbidity for this group of patients. The purpose of this review is to discuss appropriate selection of morbidly obese patients for ambulatory surgery. ⋯ Recent evidence suggests that carefully selected morbidly obese patients can safely undergo surgery on an ambulatory basis. Individualized evaluations taking into account patient-related factors, surgery-related factors, and anesthesia-related factors should dictate which patients are appropriate for ambulatory surgery.
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Curr Opin Anaesthesiol · Feb 2016
ReviewEchophysiology: the transesophageal echo probe as a noninvasive Swan-Ganz catheter.
In an attempt to make cardiovascular monitoring less invasive and more effective, transesophageal echocardiography is progressively being used in critically ill patients suffering from hemodynamic instability. This review analyses the capacity of transesophageal echocardiography to fully replace the pulmonary artery catheter in the management of hemodynamic impairment, as transesophageal echocardiography similarly allows for the measurement of central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, stroke volume and cardiac output, and systemic vascular resistance. ⋯ Transesophageal echocardiography has the potential to offer a noninvasive, valid alternative to Swan-Ganz catheters in the hemodynamic assessment of patients in the perioperative period.