Anesthesiology clinics
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Anesthesiology clinics · Jun 2011
ReviewLocal anesthetic systemic toxicity: prevention and treatment.
Anesthesia is a sine qua non for most surgeries. Like any medical advance, progress in regional anesthesia has not come without its share of complications, including a spectrum extending from localized nerve injury to systemic cardiovascular toxicity and death. This article discusses the mechanisms and clinical presentation, prevention, treatment, and future trends of local anesthetic systemic toxicity. The adverse effects of lipid emulsion therapy are also included.
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Postoperative complications are directly related to poor surgical outcomes in the elderly. This review outlines evidence based quality initiatives focused on decreasing neurologic, cardiac, and pulmonary complications in the elderly surgical patient. ⋯ However, some recommendations for adults can be applied to the geriatric surgical population. In the future, process measures may provide a more global assessment of quality in the elderly surgical population.
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Anesthesiology clinics · Mar 2011
ReviewHealth care quality in end-of-life care: promoting palliative care in the intensive care unit.
Seminal articles published in the late 1990s instigated not only an intense interest in health care quality but also a new era of research into quality end-of-life care, particularly in intensive care units (ICUs). ICUs can improve health care quality at the end of life by better using palliative care services and palliative care-related principles. This article details how the interest in health care quality has spurred a similar interest in end-of-life and palliative care in ICUs, defines palliative care and describes how it improves health care quality, and highlights barriers to the incorporation of palliative care in ICUs.
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Anesthesiology clinics · Mar 2011
ReviewUsing real-time clinical decision support to improve performance on perioperative quality and process measures.
Anesthesia information management systems (AIMS) are becoming more commonplace in operating rooms across the world and have the potential to help clinicians measure and improve perioperative quality. However, to realize the full potential of AIMS, clinicians must first understand their capabilities and limitations. This article reviews the literature on AIMS, focusing on areas where AIMS have been shown to have a meaningful impact on quality, safety, and operational efficiency.
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This article summarizes the current state of technology as it pertains to quality in the operating room, ties the current state back to its evolutionary pathway to understand how the current capabilities and their limitations came to pass, and elucidates how the overlay of information technology (IT) as a wrapper around current monitoring and device technology provides a significant advance in the ability of anesthesiologists to use technology to improve quality along many axes. The authors posit that IT will enable all the information about patients, perioperative systems, system capacity, and readiness to follow a development trajectory of increasing usefulness.