Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Dec 2007
ReviewAre there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?
As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed. ⋯ When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.
-
Curr Opin Anaesthesiol · Dec 2007
ReviewLow-dose aspirin and clopidogrel: how to act in patients scheduled for day surgery.
With the increasing use of antiplatelet drug treatment, complications resulting from its interference with invasive procedures (surgery or regional anaesthesia) have become an everyday challenge to the surgical team. The purpose of this review is to examine the most recent findings and integrate them into the ambulatory surgery setting. ⋯ Most ambulatory surgical procedures present low bleeding risk. The current attitude in this setting is to maintain aspirin therapy and possible antiplatelet drug inhibitors throughout the perioperative period. High-risk patients proposed for high-risk surgery should not be treated as outpatients.
-
Improving perioperative efficiency and throughput has become increasingly important in facilitating the fast-track recovery process following ambulatory surgery. This review focuses on the important role played by the anesthesiologist as a perioperative physician in fast-track ambulatory surgery. ⋯ The pivotal role played by the anesthesiologist as the key perioperative physician in facilitating the recovery process has assumed increased importance in the current outpatient fast-track recovery environment. The choice of premedication, anesthetic, analgesic and antiemetic drugs, as well as cardiovascular, hormonal and fluid therapies, can all influence the ability to fast-track outpatients after ambulatory surgery.
-
Curr Opin Anaesthesiol · Dec 2007
ReviewManaging intergenerational differences in academic anesthesiology.
Common definitions for workplace generations are the silent generation (born 1925-1945), the baby boomer generation (1946-1962), generation X (1963-1981), and generation Y (1982-2000). Distinct motivational and value perceptions stereotype generations. This review defines the characteristics of workplace generations today and provides insight into how differences influence the workplace environment. ⋯ Understanding, improved communication strategies, mentorship, and flexibility in methods employed to achieve common goals are most likely to capture the interest and cooperation of members of generation X and possibly Y. Future studies should test effects of particular interventions on outcome in terms of recruitment and performance milestones.
-
The number of alarms in the anaesthesia environment has gone from none to many dozens during the past 50 years. Until recently, each equipment manufacturer designed their own alarm set, resulting overall in a chaotic acoustic environment. Anaesthesiologists tend to have an uneasy relationship with monitoring alarms. On one hand they warn of mishaps, but on the other the many unnecessary alarms can be irritating and actually impede clinical care. There is evidence that these factors prevent alarms from realizing their full potential to enhance patient safety. This review explores current developments in clinical alarm design and technology. ⋯ The disadvantages of current clinical alarms have been identified and are in the process of being addressed.