Anesthesiology clinics
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Health care quality and safety are becoming more transparent, and consumers will increasingly value safety and quality rating in choosing where they go for surgery. Perioperative services are major drivers to a hospital's safety rating. Surgical services are often the most, or one of the most, profitable services, and loss of referrals and poor media reports will directly reduce margins. This article aims to guide leaders and perioperative staff in how to start improving perioperative quality and safety in health care and surgical services.
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Anesthesiology clinics · Sep 2012
Review Case ReportsInterdisciplinary rounds in the postanesthesia care unit: a new perioperative paradigm.
Patients in the perioperative and postanesthesia care unit (PACU) experience several transitions in patient care at the same time that the majority of major morbidities will arise. The transitions for these patients are at the critical juncture between surgery and a steady sustained recovery. Historically these important medical problems have been addressed as a nonformalized process. The authors have introduced a formalized process, based on interdisciplinary rounding strategies used in intensive care units, to attend patients and address problems.
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Pain management in the postanesthesia care unit (PACU) is continually evolving, with several new nonopioids expanding the list of available agents. Pain in the PACU is not an inevitable outcome of surgery. ⋯ Accurate assessment of the characteristics of pain will direct rational drug choices while minimizing side effects. Better management of pain in the PACU setting will likely improve patient satisfaction and facilitate shorter PACU stays.
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Anesthesiology clinics · Sep 2012
ReviewManagement of postoperative nausea and vomiting: how to deal with refractory PONV.
Postoperative nausea and vomiting (PONV) constitutes a significant factor in delaying recovery after anesthesia and impairing patient satisfaction. To date the prevention of PONV using single or multimodal interventions, usually based on risk assessment, has gained some popularity. ⋯ This review comments mainly on the management of refractory PONV. As the data on coping with established PONV are rare, further studies focusing on treatment of established PONV are needed.
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General anesthesia and surgery are associated with changes in the shape of the chest that result in atelectasis, a major factor in the development of postoperative respiratory failure. Postoperative noninvasive positive pressure ventilation (NIPPV) has been shown to improve oxygenation and ventilation for high-risk patients. NIPPV has been used as rescue therapy for patients developing acute respiratory distress postoperatively, and appears to be most frequently successful in patients whose problem is atelectasis or obesity. Failure to respond to NIPPV after 20 minutes is usually an indication of intubation, mechanical ventilation, and transfer to the intensive care unit.