Current opinion in anaesthesiology
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This article will provide a review of mentorship in academic medicine. The review will include definitions and an overview of the evidence supporting the benefits, barriers, and structure of mentorship programmes in academic medicine and anesthesia. Finally, we will identify areas of further research. ⋯ Mentorship has been demonstrated to be an integral part of training and career development in academic medicine and benefits both mentees and mentors. Despite the promotion of mentorship in many academic anesthesia departments, little is published in the available literature supporting mentorship in anesthesia.
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Curr Opin Anaesthesiol · Dec 2011
ReviewThe potential benefits and the role of cerebral monitoring in carotid endarterectomy.
The benefit of carotid endarterectomy (CEA) in patients with symptomatic severe carotid stenosis is highly dependent on the perioperative stroke rate. Cerebral monitoring plays an important role in reducing the perioperative stroke rate as it allows detection of the main causes of perioperative stroke, being embolism, intraoperative hypoperfusion and postoperative hyperperfusion syndrome. However, some physicians doubt about the benefit of cerebral monitoring and consider it costly and time consuming. The aim of this review is to provide an overview of the available cerebral monitoring modalities and their role in CEA. ⋯ In our opinion, cerebral monitoring during CEA is essential because it provides direct information regarding new neurological deficits, which might otherwise be missed. Intraoperative cerebral monitoring provides immediate feedback to the treating physician allowing prompt correction in tissue handling. Several monitoring modalities are available for cerebral monitoring in CEA, but no single test is comprehensive. Therefore, a combination of several monitoring modalities with each specific strength not only during but also after CEA is recommended to cover all needs and reduce the perioperative stroke rate.
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Curr Opin Anaesthesiol · Dec 2011
ReviewBlocks for pain management in children undergoing ambulatory surgery.
Data from the USA show that the number of paediatric outpatient procedures has increased by almost 50% during the time period 1996-2006. Despite this increasing trend with regards to ambulatory surgery in children postoperative analgesia is still often suboptimal. The aim of this review is to give an overview of different regional anaesthesia techniques that successfully can be used in paediatric ambulatory surgery. ⋯ Current evidence strongly supports the use of various regional anaesthetic techniques in paediatric outpatient surgery. However, further studies are needed to identify the incidence and severity of pain following different common ambulatory surgical procedures in children as well as comparative prospective randomized trials comparing different regional techniques as well as comparing regional anaesthesia to the best current combination of oral analgesics.
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Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range from 10-70% after surgery. Postoperative delirium was found to be associated with persisting cognitive deficits, increased physical dependence and institutionalization, and increased mortality. It is a condition particularly relevant to patients with increasing age. ⋯ Delirium may have an impact on patients' outcomes beyond their stay in hospital, depending on preoperative comorbidities. Delirium can be devastating for activity of daily living, cognitive performance and survival. Predisposing factors should be recognized preoperatively; precipitating factors such as preoperative fasting, deep sedation and choice of psychotropic drugs, including sedatives, should be reconsidered. Regular structured delirium screening is the precondition for early detection and treatment. Treatment options include cognitive training programmes, anti-inflammatory measures and antipsychotic drugs.