Anesthesiology clinics of North America
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This article describes the efforts of a group of anesthesiologists at Rex Hospital in Raleigh, North Carolina, to provide a wide range of anesthesiology and perioperative services. The group's philosophy that anesthesiologists are best positioned to provide such a range of services is exemplified by the work that this group performs in a 400-bed community hospital. The group's primary mission is to provide operating room anesthesia and comprehensive perioperative medicine services. This model of anesthesiologists' involvement is one example of the ways anesthesiologists can and should be involved in perioperative medicine and other acute care services in hospitals today to secure a brighter and more stable future for themselves and for their specialty.
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Anesthesiol Clin North America · Sep 2000
ReviewPerioperative management issues in pediatric patients.
Recent developments in perioperative practice, emphasizing issues that are of greatest concern in pediatric patients, are reviewed in this article. Many areas bear further evaluation in the evolving field of perioperative medicine: Effective techniques of psychologic preparation for children and their parents in an era in which the family rarely encounters the hospital environment before the day of surgery Application of newer intraoperative anesthetics, such as new narcotics and muscle relaxants, to shorten PACU and pediatric ICU stay while maintaining safety and comfort Critical evaluation of current methods of pain management to optimize comfort, while minimizing cost of such management in an increasingly cost-conscious health care environment The recent advent of a process for credentialing pediatric anesthesia fellowship programs, which requires a research component, bodes well for the prospect of finding answers to some of these questions.
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Anesthesiology faces many challenges in the years ahead. To meet these challenges, the author hypothesizes that perioperative medicine, which includes the spectrum of care from preoperative assessment to postoperative care, offers the best chance for the specialty to survive and prosper. ⋯ Implementation may be difficult and the author explores how a transition from traditional procedure-focused anesthesiology to a broader based specialty may be accomplished. The special needs of perioperative medicine and how they differ from anesthesiology are also presented.
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Anesthesiol Clin North America · Sep 2000
Outcomes in perioperative medicine and anesthesiology. Into the next millennium.
Although the development of outcomes research in perioperative medicine and anesthesiology has focused on traditional clinical outcomes, there seems to be a transition toward more global assessments of patient-related outcomes. Present trends in outcomes research and EBM may promise an improvement in individual patient and overall quality of care. New roles and opportunities in perioperative medicine and anesthesiology provide additional venues for outcomes research in this millennium.
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Anesthesiol Clin North America · Sep 2000
Critical care and perioperative medicine. How goes the flow?
The specialty of anesthesiology is at a crossroad. Do anesthesiologists stay in the illusionary safe harbor of the operating room and allow critical care anesthesiologists to float alone? How can in-fighting with other medical and nonmedical providers be avoided, while maintaining or expanding the historic and hopefully future roles of anesthesiologists as hospital-based physicians? A different tact is required to redefine the scope of the practice with broadened training to provide increased expertise in the evolving medical marketplace. This approach would include solid training in business, informatics, data management, and critical thinking on outcomes. ⋯ Regarding the question of turf and ownership of the ICU, the authors suggest pursuing the higher ground of an excellent scope of practice, which facilitates the care and activities of surgical and primary care colleagues. These colleagues, administrators, and governmental agencies will have to be re-educated to support training and provide equitable remuneration. Appropriately trained anesthesiologist-intensivists can complement many other care providers, while providing a wide range of services with an economy of care, whether in a semiclosed or closed ICU setting.