Anesthesiology clinics
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This article updates acute pain management in ambulatory surgery and proposes a practical three-step approach for reducing the impact and incidence of uncontrolled surgical pain. By identifying at-risk patients, implementing multimodal analgesia, and intervening promptly with rescue therapies, the anesthesiologist may improve outcomes, reduce cost, and optimize the patient's experience and quality of recovery.
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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.
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With the continuous increase in the numbers and complexity of cases being done as ambulatory procedures, striking a balance between operational efficiency, patient safety, and patient satisfaction has become increasingly difficult. This article summarizes the latest evidence and consensus with regard to discharging an ambulatory patient home, the use of patient recovery scoring systems for protocol-based decision making, the concept of fast-track recovery, and requirements for patient escort. Fast-tracking (ie, bypassing the postanesthesia care unit) is an acceptable and safe pathway, provided careful patient selection and assessment are performed.