Anesthesiology clinics
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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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Perioperative hyperglycemia has potential significant adverse consequences of increased mortality and morbidity including surgical site infection, renal insufficiency and anemia requiring transfusion. Both diabetic and non-diabetic patients are affected adversely by perioperative hyperglycemia. ⋯ Moreover, ideal target glucose range as well as the appropriate patient population(s) for whom glycemic control offers the most benefit have yet to be fully elucidated. However, there are clear potential adverse consequences of tight control such as hypoglycemia.
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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.