Current opinion in anaesthesiology
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For patients requiring surgery in the prone position, an alternative to a traditional supine induction is allowing the patient to position themselves comfortably prone and inducing anesthesia in that position. The purpose of this review is to examine the current literature and evaluate the safety of induction of anesthesia in the prone position. ⋯ The reviewed literature shows that elective prone induction of anesthesia using supraglottic airways, in select patients, is feasible and associated with very low complication rates; however, there is insufficient evidence to suggest that this should be done routinely.
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Incidence of obesity continues to rise and ambulatory surgical centers will need to be prepared for the increase in the obese surgical patients. This review aims to provide recent updates in managing the obese patients in an ambulatory surgical center and to address key clinical questions, such as patient selection, assessment and optimization, as well as important perioperative consideration. ⋯ With extra considerations and meticulous perioperative management, it is well tolerated to accept obese patients for ambulatory surgery. The super-obese patients, however, are at a higher risk for perioperative adverse events.
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Curr Opin Anaesthesiol · Dec 2014
ReviewThe Helsinki Declaration on Patient Safety in Anaesthesiology: the past, present and future.
Four years after the launch of the Helsinki Declaration on Patient Safety in Anaesthesiology, it is of interest to assess its role in European and Global Patient Safety efforts. ⋯ The launch of Helsinki Declaration of Patient Safety in Anaesthesiology in 2010 was a major step forward for patient safety initiatives in European and Global anesthesiology. Several steps have been taken in the 4 years that have passed, but the task needs continuous attention to ensure that every patient received the safest possible anesthesiology care.
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As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly patients will assume increased importance. ⋯ This review article describes the demographics of ambulatory surgery in the elderly population. This review article describes the effects of aging on the responses of geriatric patients to anesthetic and analgesic drugs used during ambulatory surgery. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative side-effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. Finally, we discuss the future challenges related to the continued expansion of ambulatory surgery practice in this growing segment of our surgical population. The role of anesthesiologists as perioperative physicians is of critical importance for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. Providing high-quality, evidence-based anesthetic and analgesic care for elderly patients undergoing elective operations on an ambulatory basis will assume greater importance in the future.