Current opinion in anaesthesiology
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There has been an explosion of medical information in the past decade. Current clinical practice demands that anesthesiologists be aware of current treatments and procedures, along with the latest practice standards and guidelines. The need to be able to rapidly retrieve relevant, accurate clinical information at the point of care is now felt more than ever. This review explores the impact of clinical medical librarians, with particular emphasis on their application in the perioperative setting. ⋯ Anesthesiologists have particular information needs for which the physical library is no longer sufficient. New outcome measures to define the 'success' of clinical medical librarian programs need to be formulated, and economic considerations need to be factored into these programs.
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To present the evidence available for the management of pain, for the prevention of nausea and vomiting, and for the best anaesthetic technique during ambulatory surgery. ⋯ Pain should be prevented adequately and treated vigorously. Postoperative nausea and vomiting is common and should be prevented in the at-risk patient. The choice of inhalation agents during ambulatory surgery is of minor importance in recovery from anaesthesia.
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We examined the advantages and disadvantages of certifying additional subspecialties in anesthesiology from five vantage points - patients, generalist anesthesiologists, subspecialist anesthesiologists, departments of anesthesiology, and society as a whole - in order to recommend a course of action. ⋯ Based on our examination, from the five perspectives given above, we recommend that training in all subspecialties of anesthesiology be encouraged. Official fellowship accreditation and subspecialty certification, however, should be reserved for subspecialties in which anesthesiologists provide services comparable to those provided by nonanesthesiologist subspecialists, such as critical care medicine and pain medicine.
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Perioperative beta-blockade has been advocated by multiple authors and recent guidelines as a strategy to reduce cardiac risk in noncardiac surgery. Knowledge about application of this treatment modality to the ambulatory surgery population is poor. ⋯ Based upon the available evidence and guidelines, patients currently taking beta-blockers and undergoing ambulatory surgery should continue these agents and protocols employing this strategy should be beneficial. In patients who are not currently taking beta-blockers and in whom long-term therapy is not warranted, current evidence does not support instituting prophylactic therapy in the ambulatory surgery population.
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To summarize recent findings for the optimal airway device for patients in the operating room and for medical personnel with limited experience in out-of-hospital airway management. ⋯ Extraglottic airway devices are increasingly used for airway management not only in patients for elective surgery, but also in out-of-hospital settings, when less experienced personnel have to secure the airway.