Best practice & research. Clinical anaesthesiology
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With the expansion of ambulatory surgery in the Western world over the last 10 years, it has become increasingly important to identify patients at risk of perioperative complications and to use appropriate methods to decrease these risks. The confidential enquiry into perioperative deaths was one of the first national programmes instituted to identify patients at risk after the operation. Although the focus for this initial enquiry was on perioperative mortality, recent developments have increasingly focused on identification of perioperative morbid events. ⋯ Later, strategies are discussed which could reduce the perioperative general and cardiorespiratory risks in the ambulatory surgical patient. Many of these strategies are derived from the inpatient since appropriate data in outpatients are lacking. Future studies should thus focus on data derived from outpatients and prospective, randomized, double-blind studies in a large population of patients in order to first identify the patient at risk and subsequently to use drugs and techniques that reduce these perioperative risks.
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Despite advances in our understanding of the neurobiology of nociception, postoperative pain continues to be undertreated. There are many modalities that may provide effective postoperative analgesia, including systemic (e.g. opioids, non-steroidal anti-inflammatory agents) and regional analgesic options. The particular modality or modalities utilized for a particular patient will depend on the risk-benefit profile and patient preferences. Ideally, analgesic options should be incorporated into a multimodal approach to facilitate patient recovery after surgery.