Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Aug 2008
ReviewAnesthesia outside the operating room in the office-based setting.
The majority of anesthesia services provided outside the operating room or ambulatory surgery center is in the office-based setting. This review will focus on three areas that are critical to office-based anesthesia: safety, quality of care and patient satisfaction. ⋯ There is rapid growth for the need of safe and high quality office-based anesthesia. To meet these needs, a special set of skills is required, which may require expanded exposure and experience during training. An office-based anesthesia central data repository is needed for benchmarking and identifying areas for improvement. Finally, with advances in surgical technology, there is a need for focused research in office-based anesthetic techniques and modalities and patient satisfaction.
-
To discuss closed-loop systems, the engineering behind them, and the application of these systems. ⋯ The future anesthesiologist may devote less time to easily delegated tasks when in the operating room. The ability of computers to maintain variables in a set range allows some tasks to be automated. Although monitoring of these systems will never be completely eliminated, the necessity for minute-to-minute intervention may.
-
To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. ⋯ Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.
-
Interventional pain management is an emerging specialty that uses procedures to diagnose and treat chronic pain. Most of these procedures are performed percutaneously and carry a risk of bleeding. Patients undergoing these treatments may be receiving exogenous anticoagulants. The pain practitioner faces a dilemma in performing an elective procedure on a patient with a bleeding risk. ⋯ Knowledge about normal and impaired hemostasis, coupled with a bleeding risk tool, enables practitioners to make informed decisions when offering interventional pain care to their patients.