Anesthesiology clinics
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Anesthesiology clinics · Dec 2018
ReviewCreating a Pathway for Multidisciplinary Shared Decision-Making to Improve Communication During Preoperative Assessment.
Shared decision-making (SDM) is essential for high-quality surgical care. Barriers to SDM exist in clinical practice but there is evidence these obstacles can be overcome. ⋯ Multidisciplinary decision-making before surgery is an opportunity for anesthesiologists and other perioperative professionals to improve surgical care. The authors present an example of a successfully implemented pathway for high-risk surgical patients at a tertiary care center, leveraging the preoperative anesthesia evaluation.
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Anesthesiology clinics · Dec 2018
ReviewManagement of Challenging Pharmacologic Issues in Chronic Pain and Substance Abuse Disorders.
Drug abuse and addiction are persistent problems in the United States and around the world. This is an ongoing issue for health care providers, as substance abuse is seen in 25% to 40% of patients admitted to hospitals for general treatment. Many patients with substance use disorders have a higher risk for adverse events; however, only a small percentage will volunteer information regarding prior substance use. This article discusses the present opioid crisis, mechanisms behind chronic pain and substance abuse, current clinical findings, treatment therapies, and abuse deterrents.
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Anesthesiology clinics · Dec 2018
ReviewPreoperative Management of the Geriatric Patient: Frailty and Cognitive Impairment Assessment.
As the population ages, more geriatric patients will be presenting for surgical procedures. Preoperative evaluation seeks to assess patients for geriatric syndromes: frailty, sarcopenia, functional dependence, and malnutrition. Age-related changes in physiology increase risk for central nervous system, cardiovascular, pulmonary, renal, hepatic, and endocrine morbidity and mortality. Identification of various comorbidities allows for preoperative optimization and for opportunities for intervention including nutritional supplementation and prehabilitation, which may improve postoperative outcomes.