Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2016
ReviewDo ultrasound-guided regional blocks signify a new paradigm in high-risk patients?
It has been suggested for many years that regional anaesthesia is advantageous in high-risk patients, either as the sole anaesthetic or in combination with general anaesthesia. Regional techniques are safe and even more so when guided by ultrasound. ⋯ Nevertheless, complications do still occur and benefits of a specific regional nerve blockade need to be weighed against potential risks on an individual basis. The emergence of reasonably priced, easy-to-use ultrasound machines facilitates regional anaesthesia, and this kind of anaesthesia may become the standard of care in high-risk patients.
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Best Pract Res Clin Anaesthesiol · Jun 2016
ReviewPreparing the patient for surgery to improve outcomes.
The time between contemplation of surgery and the procedure offers a window of opportunity to optimize patients' nutritional, functional and psychological state prior to surgery. Traditionally, preoperative pathways have focused on the underlying disease process and 'fitness for surgery' with physical pre-assessment and risk counselling late in the pathway when little time is available to intervene. With an increasingly elderly and co-morbid surgical population, early physiological assessment and multidisciplinary collaborative decision-making is increasingly important. ⋯ Patient education and engagement is important if compliance with behavioural change is to be achieved and maintained. To date, there has been evidence supporting preoperative exercise training, smoking cessation, reduction in alcohol intake, anaemia management and psychosocial support. Further research is needed to identify the most effective elements of these complex preoperative interventions, as well as their optimum timing and duration.