Anesthesiology clinics
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This article provides a review of key concepts in quality management (QM) for ambulatory anesthesia. The importance of collecting data from every case is emphasized, and important outcome measures are recommended. The use of specific data collection tools and methodologies is discussed, including the national registry projects of the Society for Ambulatory Anesthesia and the Anesthesia Quality Institute. A brief overview is provided of how to use QM data to improve patient outcomes within an anesthesia practice.
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This article informs anesthesiologists of some of the legal issues they may encounter in connection with ambulatory surgical center-based or office-based practice. The primary legal issues that anesthesiologists face in connection with practice in such settings can be broken down into practice-related issues and ownership-related issues. Given the complexity of legal issues relating to ambulatory anesthesia, anesthesiologists are advised to consult counsel at an early stage so as to understand the issues that may apply to their practices.
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Peripheral nerve blocks (PNBs) provide significant improvement in postoperative analgesia and quality of recovery for ambulatory surgery. Use of continuous PNB techniques extend these benefits beyond the limited duration of single-injection PNBs. ⋯ This article provides a broad overview of the indications and clinically useful aspects of the most commonly used upper and lower extremity PNBs in the ambulatory setting. Emphasis is placed on approaches that can be used for single-injection PNBs and continuous PNB techniques.
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Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed.
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Chronic pain is a symptom that patients fear significantly. To treat and alleviate pain, physicians perform various interventions for which patients often need to be immobile for long periods of time. To improve patient satisfaction and relief anxiety of those complex procedures, pain physicians use various anesthetic techniques for their pain-relieving procedures that range from local skin infiltration to general anesthesia with endotracheal intubation. This article describes the anesthetic techniques used in interventional pain procedures and their indications, side effects, and complications.