Current opinion in anaesthesiology
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There is an increasing interest in the application of near-infrared spectroscopy (NIRS) as a monitoring tool in noncardiac surgery. This review summarizes the latest developments and current evidence for the use of NIRS in the noncardiac intraoperative setting. ⋯ NIRS offers noninvasive monitoring of cerebral and overall organ oxygenation in a wide range of clinical scenarios. There is an increasing evidence that the optimized cerebral oxygenation is associated with improved outcomes in both neurologic and major organ morbidity in a variety of surgical settings.
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Curr Opin Anaesthesiol · Dec 2015
ReviewContinuous peripheral nerve blocks in the ambulatory setting: an update of the published evidence.
To review the evidence recently published involving the use of continuous peripheral nerve blocks (cPNBs) in the ambulatory setting. ⋯ Recent advancements in equipment for cPNB facilitate the usage in the ambulatory setting. Research-supported ambulatory cPNB indications have expanded to include pediatric subpopulations and major breast surgery, while further evidence mounts for its efficacy in patient populations with previously demonstrated benefits, such as foot, ankle and shoulder surgery.
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Curr Opin Anaesthesiol · Dec 2015
ReviewLaryngeal mask airway indications: new frontiers for second-generation supraglottic airways.
Because of the many advantages of supraglottic airways (SGA) compared to mask ventilation and endotracheal intubation, their areas of application are constantly expanding. The development of second-generation SGAs in particular has led to a widening of the indications for use thanks to the improved oropharyngeal leak pressure and the possibility of inserting a gastric tube. The identification of possible malpositions and any increased ventilation requirements using simple clinical tests must be given particular emphasis. The question of patient safety for expanded indications has to be evaluated. ⋯ The use of second-generation SGA for expanded indications seems useful and safe, provided the contraindications are heeded, the placement and performance tests are successfully completed and there is adequate clinical expertise.
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Curr Opin Anaesthesiol · Dec 2015
ReviewAirway management for anaesthesia in the ambulatory setting.
The number of anaesthetic procedures in the ambulatory setting is steadily increasing. During the last years, more and more patients with complex medical conditions undergo ambulatory interventions. This review will focus on airway management practices, but especially on techniques used in the ambulatory setting. It will highlight recent literature published in the focus of ambulatory anaesthesia and will discuss relevant findings of the last year. ⋯ There are several points which should be considered for ambulatory anaesthesia. Selected patient groups (e.g., obstructive sleep apnoea, obesity) may have a higher anaesthesia-related risk. To handle the more and more complex conditions in a growing number of ambulatory patients, straightforward concepts, especially for the (un)expected difficult airway, are required.
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Curr Opin Anaesthesiol · Dec 2015
ReviewState-of-the-art usage of simulation in anesthesia: skills and teamwork.
This review describes the level of evidence for the use of medical simulation in anesthesia. It also discusses the topic of realism in simulation and its use for assessment. ⋯ Simulation for skill and team training should be a mandatory component for anesthesia residency programs and continuous medical education. The 'see one, do one, teach one' approach is obsolete and should be abandoned.