Anesthesiology clinics
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Greater understanding of the pathophysiology and mechanism of acute pain has led to advances in pharmacologic therapy. Understanding the principles of multimodal therapy along with surgical-specific protocols leads to improved outcome in patients. However, further large-scale randomized trials need to be performed to further establish and demonstrate the long-term benefit of multimodal therapy for patients undergoing surgery.
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Anesthesiology clinics · Mar 2012
ReviewPalliative medicine in the surgical intensive care unit and trauma.
The purpose of palliative medicine is to prevent and relieve suffering and to help patients and their families set informed goals of care and treatment. Palliative medicine can be provided along with life-prolonging treatment or as the main focus of treatment. ⋯ Data show involving palliative medicine in the SICU results in decreased length of stay, improved communication with families and patients, and earlier setting of goals of care, without increasing mortality. The use of triggers for palliative medicine consultation improves patient-centered care in the SICU.
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In the surgical intensive care unit (SICU), the stress of having a critically ill loved one creates significant bereavement and emotional needs for family members. Surgical palliative care has expanded; clinicians do not just treat the patient, but now include the family within the scope of care. Understanding and treating complicated grief, and the emotional and educational needs of the family improves family outcome, improves the surrogate family's ability to act as decision makers, and ultimately may positively affect patient survivor outcome. Care of families in the SICU requires interdisciplinary teams and palliative care processes to appropriately address their needs.
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Anesthesiology clinics · Dec 2011
Current sedation practices: lessons learned from international surveys.
Limitations are inherent to surveys. Most surveys have low response rates, which raises the issue of responder bias. Another limitation of self-report surveys stems from the possible differences between stated and actual practice. ⋯ Overall, there is a trend toward lighter sedation, along with a shift from benzodiazepines toward propofol, and from morphine toward fentanyl and remifentanil. Despite the publication of numerous studies and guidelines for sedation and analgesia, actual practice differs from recommended practice, suggesting that the impact of clinical trials and guidelines on physician practice is quite low. It is clear that there remain substantial barriers to the incorporation of sedation scales, protocols,and daily interruption into routine ICU care.
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Anesthesiology clinics · Dec 2011
Delirium: an emerging frontier in the management of critically ill children.
Delirium is a syndrome of acute brain dysfunction that commonly occurs in critically ill adults and most certainly is prevalent in critically ill children all over the world. The dearth of information about the incidence, prevalence, and severity of pediatric delirium stems from the simple fact that there have not been well-validated instruments for routine delirium diagnosis at the bedside. ⋯ In adults, delirium is responsible for significant increases in both morbidity and mortality in critically ill patients. The advent of new tools for use in critically ill children will allow the epidemiology of this form of acute brain dysfunction to be studied adequately, will allow clinical management algorithms to be developed and implemented following testing, and will present the necessary incorporation of delirium as an outcome measure for future clinical trials in pediatric critical care medicine.