Current opinion in anaesthesiology
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In the perioperative period, acute heart failure can result from a variety of conditions, and treatment may vary considerably depending on its mechanism. This review aims to provide conceptual framework by selectively presenting recent knowledge and advances in acute heart failure therapies including drugs (inotropes, diuretics) and devices (mechanical assistance, biventricular pacing, ultrafiltration). ⋯ Poor data exist in the perioperative setting concerning acute heart failure therapies. Large trials are needed to support the use of levosimendan, mechanical assistance, utrafiltration and biventricular pacing in the perioperative setting. The prognostic role of natriuretic peptides was confirmed in the perioperative period.
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Evidence is emerging that delirium is associated with both short-term and long-term morbidity and mortality. This review highlights the epidemiology, outcomes, prevention and treatment strategies associated with delirium after cardiac surgery. ⋯ Clinicians in the ICU must recognize the impact of delirium in predicting long-term outcomes for patients. Further research is needed in determining interventions that will be effective in preventing and treating delirium in cardiac surgical setting.
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Curr Opin Anaesthesiol · Apr 2014
ReviewDeveloping a trauma curriculum for anesthesiology residents and fellows.
The board certification process for qualification by the American Board of Anesthesiology is undergoing significant review. A basic sciences examination has been added to the process and the traditional oral examination is evolving into a combined oral interview and practical skills assessment. These recent developments, as well as the growing body of evidence regarding the resuscitation of trauma patients, call for a revision in the curriculum beyond the documentation of participation in the anesthetics of 20 trauma patients. ⋯ Currently, the curriculum for trauma anesthesia requires only that residents participate in the anesthetics of 20 trauma patients. There is no plan for, and little literature regarding, a more extensive educational program. This offers a unique opportunity to innovate a novel curriculum in the anesthesiology residency. The American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness has designed a curriculum that can serve as a template for this important step forward in anesthesiology education.
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Curr Opin Anaesthesiol · Apr 2014
ReviewThe changing anesthesia economic landscape: emergence of large multispecialty practices and Accountable Care Organizations.
In this review, we evaluate the current US employment models for healthcare in general and anesthesiologists in particular and the emergence of large, multispecialty physician groups and the forces behind this change to the current anesthesia practice model. We will also examine the present payment method for anesthesiologists and determine how Accountable Care Organizations will affect the future payment models. ⋯ This is the most critical time in the specialty of anesthesiology from an economic viewpoint, and significant threats and opportunities will arise for anesthesiologists in how they are reimbursed, and how they demonstrate the delivery of quality care to patients.