Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2006
ReviewRisk reduction: perioperative smoking intervention.
Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of postoperative intensive care admission. ⋯ An intensive, individual approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation, and offered a smoking intervention programme whenever possible.
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Best Pract Res Clin Anaesthesiol · Jun 2006
Review Comparative StudyRegional anaesthesia versus general anaesthesia, morbidity and mortality.
The regional versus general anaesthesia debate is an age-old debate that has brought about few clear answers. Most concur that multiple factors including the patient, the surgery, the method of regional and general anaesthesia, and the quality of perioperative care, all influence surgical outcome. ⋯ This review considers general issues such as the type of available evidence, and its limitations, particularly with regard to the relatively broad question of neuraxial versus general anaesthesia. It then assesses current evidence on regional versus general anaesthesia for specific scenarios such as hip fracture surgery, carotid endarterectomy, Caesarean section, ambulatory orthopaedic surgery, and postoperative cognitive dysfunction in elderly patients after non-cardiac surgery.
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Best Pract Res Clin Anaesthesiol · Jun 2006
ReviewPatient satisfaction with anaesthesia care: what is patient satisfaction, how should it be measured, and what is the evidence for assuring high patient satisfaction?
Patient satisfaction is a part of outcome quality. Many theories of satisfaction include patients' expectation. One definition of satisfaction is therefore the degree of congruence between expectation and accomplishment. ⋯ Based on the few available studies in anaesthesia, patient satisfaction is primarily determined by information and communication. There is great potential for improvement in this area. However, we do not know the best way to continuously improve patient satisfaction with anaesthesia care, or to what extent decisions should be shared between the anaesthetist and the patient.
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Best Pract Res Clin Anaesthesiol · Jun 2006
ReviewBenefits and harms of perioperative beta-blockade.
Cardiac events in patients undergoing surgery may have serious consequences for both short- and long-term postoperative prognosis. Recently conducted trials have not demonstrated beneficial effects of perioperative beta-blockade, although originally small trials with methodological flaws did suggest this. ⋯ The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk or diabetes, and with lower mortality in patients with high cardiac risk undergoing non-cardiac surgery. Larger randomized trials are needed to determine dosage, optimal duration, and safety of therapy, and to identify populations in whom-and how-perioperative beta-blockade may be beneficial.
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The aim of this chapter is to focus on evidence-based health economics in anaesthesia. More and more, requests for additional facilities will have to be based on detailed arguments supported by 'hard evidence' as to the gain to be expected from the patient's angle and the cost. ⋯ This chapter shows how to bring economic evaluation and systematic review together, and how to use such evaluations in the clinical setting. It shows how economics can be used to broaden the evidence base for a more efficient and equitable health policy, and sets a future research agenda for this challenging area of work in Cochrane reviews dealing with anaesthesia topics.