Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2012
ReviewRecovery after orthopedic surgery: techniques to increase duration of pain control.
Ambulatory surgery continues to expand in scope and volume. Part of this development is supported by improvements in anesthesia care, especially in the realm of postoperative analgesia, which is often outlasted by the pain. The purpose of this review is to outline methods of increasing the duration of postoperative pain control. ⋯ The ideas and findings described in this review are taken from the most recent literature and show promise of aiding in the continued improvement of patient care through their dissemination and refinement by further research. Of the modalities reviewed in current use, the continuous perineural catheter combined with systemic multimodal analgesics represents the best combination of safety and efficacy to provide prolonged postoperative analgesia.
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Curr Opin Anaesthesiol · Dec 2012
ReviewDifficult airway management in an ambulatory surgical center?
This review will focus on two key aspects of difficult airway management in an ambulatory surgical center (ASC). First, the selection process of patients with known difficult airways suitable for this environment, and second, the requirements of a difficult airway cart to manage unexpected airway problems. ⋯ The management of ambulatory surgical practices must provide suitable difficult airway management equipment as well as technical and nontechnical training. Patients may present to an ASC with expected and unexpected difficult airways. Appropriate management of these patients requires advance planning to avoid poor outcomes.
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Anesthesiologists work in a complex environment that is intolerant of errors. Cognitive errors, or errors in thought processes, are mistakes that a clinician makes despite 'knowing better'. Several new studies provide a better understanding of how to manage risk while making better decisions. ⋯ Effective decision-making and risk management reduce the risk of adverse events in the operating room. This article proposes several new decision-making and risk assessment tools for use in the operating room.
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Curr Opin Anaesthesiol · Dec 2012
ReviewIntroduction of evidence-based medicine in undergraduate medical curriculum for development of professional competencies in medical students.
Current undergraduate medical curricula in most institutions around the globe do not nurture the skills, needed for self-directed lifelong learning in medical graduates, and it needs to be reformed in such a way that the medical graduate who is trained through this reformed curriculum, possesses all the competencies of a self-directed learner. Evidence-based medicine (EBM), a new vision of physician learning which is based on continuous development and assessment of competencies needed for creating self-directed learners is to be strongly advocated for inclusion in the undergraduate medical curriculum. ⋯ Introduction of EBM in undergraduate medical curriculum helps in the development of professional competencies of self-directed learners in medical students.
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Curr Opin Anaesthesiol · Dec 2012
Review Historical ArticleHistory of anesthesia for ambulatory surgery.
Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. ⋯ Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.