Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2023
ReviewInitiatives to detect and prevent death from perioperative deterioration.
This study indicates that there are differences between hospitals in detection, as well as in adequate management of postsurgical complications, a phenomenon that is described as 'failure-to-rescue'.In this review, recent initiatives to reduce failure-to-rescue in the perioperative period are described. ⋯ Improving the complete emergency chain, including monitoring, recognition and response in the afferent limb, as well as diagnostic and treatment in the efferent limb, should lead to reduced failure-to-rescue situations in the perioperative period.
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The aim of this article is to briefly review the pediatric ambulatory surgery landscape, identify two of the most common comorbidities affecting this population, examine the influence of pediatric obesity and sleep disordered breathing (SDB)/obstructive sleep apnea (OSA) on perioperative care, and provide information that can be used when formulating site specific criteria for ambulatory surgical centers. ⋯ Our pediatric ambulatory surgical population is anticipated to demonstrate increasing rates of obesity and SDB/OSA. Bringing attention to potential perioperative complications associated with these comorbidities provides a stronger foundation upon which to formulate criteria for individual ambulatory centers. It allows for targeted anesthetic management, influences provider assignments and/or staffing ratios, and informs scheduling times. For anesthesiologists who do not practice pediatric anesthesia daily, knowing what to anticipate plays a significant role in the ability to eliminate surprises and care for these patients safely.
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Curr Opin Anaesthesiol · Dec 2023
HOCUS POCUS: ultrasound beyond regional anesthesia in the ambulatory setting.
Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point of care applications of ultrasound in perioperative care and anesthetic management with special emphasis on ambulatory practice. ⋯ Perioperative POCUS skill is a natural extension of ultrasound guided regional anesthesia. Utilizing POCUS in the perioperative period would accelerate the level of appropriate care, safety and improve outcomes in ambulatory centers. More anesthesiologists embracing POCUS would enhance patient care in a timely fashion at the ambulatory centers. POCUS in ambulatory practice can be valuable in avoiding delay or cancellation of surgeries and improving patient satisfaction.
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Curr Opin Anaesthesiol · Dec 2023
Twenty-three-hour stays in the ambulatory surgical center: benefits, pathways and protocols.
To summarize recent evidence that discusses the clinical, financial, and logistical implications of a 23 h stay postsurgical stay unit in an ambulatory surgical center (ASC). ⋯ A concurrent concern with the recent increase in outpatient surgery and medical complexity of cases performed in an ambulatory surgical center (ASC) is the possibility that patients may need overnight stay. Further, whether certain patients would benefit from anticipated 23 h observation rather than same-day discharge is an emerging topic. Overnight stays in ASCs may have financial advantages and decrease the risk of unanticipated admission with proper patient selection. The use of protocols and established pathways is key to the success of this model.
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Curr Opin Anaesthesiol · Dec 2023
Office-based anesthesia: a contemporary update on outcomes, incentives, and controversies.
The volume of office-based surgery (OBS) has surged over the last 25-30 years, however patients with increasing comorbidities are being considered for procedures in office locations. This review focuses on office-based surgery outcomes, financial incentives driving this change, and controversies. ⋯ The reported safety supports the proper selection of patients for the proper procedure in the right location. Anesthesiologists need to develop and implement safe and efficient systems to optimize patient outcomes in outpatient office settings. Further research and uniform standardized outcomes tracking are needed in the emerging specialties performing office-based surgery.