Current opinion in anaesthesiology
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To summarize and examine the updated published results on the outcome measures that can be used to assess the quality of ambulatory surgery and anesthesia. ⋯ Ambulatory surgery, as currently practiced, provides quality care that is cost-effective. Minor adverse events such as pain and postoperative nausea and vomiting are still common, and improvement could be targeted in these areas.
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Echocardiography has been used perioperatively as an important diagnostic tool since the 1980s. Introduction of this new technique has been beneficial to our practice, but has also introduced questions and issues related to methods of teaching, requirements for demonstration of competence and testing and certification processes as evidence of satisfactory completion of necessary learning parameters. This article will review the issues presented to date, how they have been addressed, and what options could be arriving in the future. ⋯ Perioperative echocardiography has rapidly become an integral part of anesthetic practice. The training and certification process has been formalized. There are still issues related to difficulty of training individuals outside core residency programs.
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Curr Opin Anaesthesiol · Dec 2006
ReviewAlveolar recruitment versus hyperinflation: A balancing act.
To address lung recruitment according to pressure/volume curves, along with regional recruitment versus hyperinflation evidence from computed tomography and electrical impedance tomography. ⋯ Positive end-expiratory pressure levels must be high enough to minimize recruitment/derecruitment cycling. Balancing recruitment versus overdistension may require thoracic tomography, to assure sufficient improvement in oxygenation while limiting hypercarbia.
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Curr Opin Anaesthesiol · Oct 2006
ReviewManagement of physiological variables in neuroanaesthesia: maintaining homeostasis during intracranial surgery.
The recent literature on the perioperative maintenance of cerebral homeostasis was reviewed. ⋯ From the clinical point of view, the recent research has added only little to the knowledge on the management of physiological parameters in neurosurgery. More adequately powered studies focusing in specific problems, and having a meaningful aim relative to outcome, are needed also in neuroanaesthesia.