Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2008
ReviewPulse oximetry and photoplethysmographic waveform analysis of the esophagus and bowel.
This article reviews the development of novel reflectance pulse oximetry sensors for the esophagus and bowel, and presents some of the techniques used to analyze the waveforms acquired with such devices. ⋯ The use of novel reflectance pulse oximetry sensors has been successfully demonstrated. Such sensors, combined with the application of more advanced signal processing, will hopefully open new avenues of research leading to the development of new types of pulse oximetry-based monitoring techniques.
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Curr Opin Anaesthesiol · Dec 2008
ReviewManagement of outcomes in the ambulatory surgery center: the role of standard work and evidence-based medicine.
Quality and safety in the manufacturing and airline industries have benefited from evidenced-based process-improvement strategies. This review investigates the rationale for application of these same processes in the ambulatory anesthesia setting. ⋯ Ambulatory surgery and anesthesia care is uniquely oriented to the application of repetitive processes in the provision of highly predictable and reproducible surgical services. Ambulatory anesthesiologists should lead the healthcare industry in the much wider adoption of standard practice protocols and team training to maximally improve the safety and quality of patients' experiences.
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Curr Opin Anaesthesiol · Dec 2008
ReviewPostdischarge complications and rehabilitation after ambulatory surgery.
To present the literature on recent developments in anesthetic and analgesic techniques in ambulatory surgery. ⋯ During the last year, several studies have demonstrated the benefits of regional anesthesia techniques in reducing postdischarge complications and improving rehabilitation. Perioperative use of the COX-2 selective inhibitor celecoxib seems to provide short-term and long-term postoperative advantages.
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The purview of ambulatory anesthesia continues to broaden in response to national interest in controlling healthcare costs and eliminating unnecessarily expensive hospital stays. Recent advances in anesthesia allow us to minimize side effects and complications of anesthesia and surgery that might otherwise delay recovery and discharge. The purpose of this review is to highlight some of these latest advances in clinical care that may soon change how we practice. ⋯ The research and advances in clinical care described will likely influence how we manage our patients in the future, eliminating the need for prolonged hospital stay after surgery.
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Curr Opin Anaesthesiol · Dec 2008
ReviewPreoperative screening, evaluation, and optimization of the patient's medical status before outpatient surgery.
Preoperative evaluation and optimization of a patient's medical condition are important components of anesthesia practice. With ever increasing numbers of patients with serious comorbidities having complex procedures as outpatients, the task of gathering information and properly preparing for their care is challenging. Improvements in assessment and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. ⋯ Preparation of patients before surgery is a necessary and vital component of perioperative medicine. Practices are developing to guide effective interventions that benefit patients and healthcare systems. Outpatients present special challenges to preoperative assessment.