Anesthesiology clinics of North America
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In children, regional anesthetic techniques are safe and effective adjuncts to general anesthesia and for postoperative pain relief. Application of the techniques described in this article will contribute to improved care for pediatric patients undergoing surgical procedures. The judicious choice of local anesthetics, along with the blockades of targeted nerves, decrease the need for supplemental analgesics in the recovery phase.
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The use of office-based surgery and anesthesia will continue to grow. The anesthesia community has embraced the opportunity to become a driving force of office-based surgery and has organized into rapidly growing groups that promote safe practice in the office setting. The Society for Office-Based Anesthesia was developed to continuously improve patient safety and outcomes in office surgery. ⋯ Anesthesia providers must continue to take active roles in organizing the office environment to ensure that safety is paramount. As the field grows, additional ways to study and improve the overall care children receive in the office should be sought. In the near future, office practice for surgery and anesthesia for children undergoing minor procedures should be a safe and effective alternative to current practices.
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Anesthesiol Clin North America · Mar 2002
ReviewPsychological preparation of the parent and pediatric surgical patient.
Some 3 million children undergo anesthesia and surgery in the United States every year; 40% to 60% of these children develop significant behavioral stress prior to surgery. Multiple interventions have been suggested to treat the preoperative behavioral stress responses in children. There is a trend toward reducing both behavioral and pharmacological preoperative interventions aimed at children, perhaps because though there is a consensus that preoperative interventions can be useful, almost no outcome studies have evaluated the effects of these interventions on measurable, clinically "important" postoperative outcomes. More research is needed in this area.
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Anesthesiol Clin North America · Mar 2002
ReviewSedation and analgesia in pediatric patients for procedures outside the operating room.
Sedation and analgesia in pediatric patients for procedures outside the operating room are becoming more frequent as health care is being driven to be more cost effective and "efficient." Although anesthesiologists may not be directly involved in sedation or analgesia outside of the operating room, there is a high likelihood that they will be asked by their institutions to be integrally involved in creating and supervising sedation policy given that the American Society of Anesthesiologists and the Joint Commission on Accreditation of Healthcare Organizations consider sedation and analgesia as part of a continuum ranging from minimal sedation to moderate sedation and analgesia, deep sedation and analgesia, and, finally, general anesthesia. Further, anesthesiologists will be asked to define, teach, and credential nonanesthesiology practitioners who perform deep sedation because these practitioners are now required to be qualified to "rescue from general anesthesia."
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Anesthesiol Clin North America · Mar 2002
ReviewNeuroanesthesia. Innovative techniques and monitoring.
Advances in neuromonitoring have provided insights into neurologic function during anesthesia. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and level of consciousness during anesthesia. The techniques discussed minimize the adverse sequelae of a variety of neurosurgical and orthopedic procedures, reducing the morbidity rates/risks in the perioperative period. ⋯ Accurate and reliable monitoring is essential, and on-going large prospective studies comparing the processed EEG or evoked potential with definable end points in both adult and pediatric populations will be necessary. The use of monitoring, such as the BIS, may improve cost efficiency by reducing the total amount of drug used to maintain anesthesia, as well as enhance recovery. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available.