Current opinion in anaesthesiology
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American Society of Aesthetic Plastic Surgery statistics show outpatient cosmetic procedures increased from 3 to 11 million (1997-2007), an increase of 457%, and $13 billion was spent. Exponential growth, complexity of cases and patients, and media attention to high-profile untoward events are accompanied with concerns for patient safety and development of safer anesthesia practices. ⋯ The methods presented improve patient safety. The number of cosmetic procedures will continue to grow exponentially and evolve additional patient safety concerns. This larger population is the foundation for prospective trials to develop evidence-based anesthesia for cosmetic surgery.
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Curr Opin Anaesthesiol · Dec 2008
ReviewRegional anesthesia techniques for ambulatory orthopedic surgery.
The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. ⋯ In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.
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Curr Opin Anaesthesiol · Dec 2008
ReviewUsing ventilation-induced plethysmographic variations to optimize patient fluid status.
Hypovolemia is one of the most frequent causes of arterial hypotension in the operating room. Pulse oximeter plethysmographic waveform, obtained using a noninvasive and widely available device, has recently shown its potential interest in predicting fluid responsiveness in mechanically ventilated patients under mechanical ventilation. This review highlights new applications of this routine monitoring. ⋯ Automatic detection of respiratory variations in pulse oximetry plethysmographic waveform amplitude can predict fluid responsiveness in the operating room in patients under mechanical ventilation and has potential for fluid optimization in this setting.
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Curr Opin Anaesthesiol · Dec 2008
ReviewChanges in skin conductance as a tool to monitor nociceptive stimulation and pain.
The skin conductance algesimeter (SCA) reflects the sympathetic nervous system influenced by changes in emotions, which releases the acetylcholine that acts on muscarine receptors, causing a subsequent burst of sweat and increased skin conductance. The SCA reacts immediately and is not influenced by hemodynamic variability or neuromuscular blockade. The use of SCA for pain and nociceptive assessment is outlined in this review. ⋯ The SCA detects nociceptive pain fast and continuously, specific to the individual, with higher sensitivity and specificity than other available objective methods.
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Curr Opin Anaesthesiol · Dec 2008
ReviewRecent advances in scenario-based training for medical education.
To summarize recent thinking about how to best design simulations and other virtual environments in medical education and training. ⋯ In presenting this framework, I hope that medical educators and practitioners can have a deeper appreciation for how to best design and implement scenario-based training.