Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2014
ReviewThe role of the anesthesiologist in perioperative patient safety.
Despite the benefits of rapidly advancing therapeutic and diagnostic possibilities, the perioperative setting still exposes patients to significant risks of adverse events and harm. Anesthesiologists are in midstream of perioperative care and can make significant contributions to patient safety and patient outcomes. This article reviews recent research results outlining the current trends of perioperative patient harm and summarizes the evidence in favor of patient safety practices. ⋯ Current research provides growing evidence for the effectiveness of several patient safety practices designed to prevent or diminish perioperative adverse events and patient harm. Future investigations will hopefully fill the numerous persisting knowledge gaps.
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Many patients presenting for surgical or other procedures in an ambulatory setting are taking new antiplatelet or anticoagulant agents. This review assesses how the novel features of these new agents affect the management of antithrombotic therapy in the ambulatory setting. ⋯ As there are few clinical studies to guide management, clinicians must make rational decisions in relation to continuing or ceasing new antithrombotic agents. This requires knowledge of their pharmacokinetics, and a careful multidisciplinary assessment of the relative thrombotic and bleeding risks in individual patients.
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Curr Opin Anaesthesiol · Dec 2014
ReviewCurrent recommendations for monitoring depth of neuromuscular blockade.
Residual neuromuscular block is a relatively frequent occurrence and is associated with postoperative pulmonary complications, including aspiration, pneumonia and hypoxia, impaired hypoxic ventilatory drive and decreased patient satisfaction. Although adequate recovery of neuromuscular function has been defined as a train-of-four ratio of at least 0.9, monitoring with a qualitative peripheral nerve stimulator makes it impossible to determine the actual train-of-four ratio. ⋯ Use of peripheral nerve stimulators allows clinicians to administer neuromuscular blocking and reversal agents in a rational manner. Routine use of quantitative monitors of depth of neuromuscular blockade is the best guarantee of the adequacy of recovery of postoperative muscle strength.
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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.