Current opinion in anaesthesiology
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This review intends to give an overview of developments in anaesthesia residency training. ⋯ Innovations in the field of educational studies have provided us with tools to improve the training of our residents. Portfolio, simulation and quality assurance are among the most prominent developments aimed at creating successful residency programmes. Financial implications of the implementation of educational innovations should, however, be considered.
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This review is aimed at highlighting the recent developments and opportunities that are likely to impact the anesthesia team of the future. ⋯ The anesthesia team of the future will require the anesthesiologist to provide expertise across the entire domain of perioperative medicine. Meaningful decision support systems rely on accurate data analysis and incorporation of current clinical guidelines and recommendations.
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We critically review brain function monitors based on the processed electroencephalogram with regards to signal quality, artefacts and other limitations in clinical performance. ⋯ Clinicians should be aware of the several limitations of the commercial devices intending to monitor the depth of anaesthesia, which may not reflect the real underlying level of unconsciousness.
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Curr Opin Anaesthesiol · Dec 2011
ReviewArterial waveform analysis in anesthesia and critical care.
In this review, we describe the basic principles of arterial waveform analysis (AWA) to assess cardiac output (CO) and cardiac preload. The validity of commercially based hemodynamic monitoring systems is discussed, together with their clinical applications and limitations. ⋯ AWA provides a less invasive and easy-to-use alternative for CO measurement. The validity of AWA devices has been verified in a variety of patients and circumstances, but their performance is compromised in the presence of hemodynamic instability, cardiac arrhythmias, or other factors disturbing the arterial pressure waveform. The definitive role of dynamic preload parameters like SVV and PPV is a matter of research. Large trials in which the value of early goal-directed therapy using this technology is studied in relation to outcome are urgently needed.