Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPatient-reported outcomes: Is this the missing link in patient-centered perioperative care?
Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in recent years. However, progress from clinical research on PROs has not been widely adopted in routine patient care. ⋯ Insufficient empirical research on appropriate PROs and its methodologies, insufficient implementation research to solve the practical issues, and insufficient data collection methods and experiences on ePROs are also discussed. Future research agenda should focus on evidence-supported, PRO-based symptom monitoring systems for early diagnosis and management of impending compromised clinical outcomes.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPrehabilitation before surgery: Is it for all patients?
To evaluate the role of prehabilitation interventions in adult patients before elective major surgery. ⋯ Studies evaluating multimodal prehabilitation interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical effectiveness is currently very limited. Future research should focus on refining interventions, exploring mechanisms, establishing minimum dosage, interrogating interactions between therapies, and urgent implementation of large-scale clinical effectiveness studies.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPrinciples for minimizing oxygen debt: can they translate to clinical application and improve outcomes?
Oxygen delivery is dependent on pulmonary gas exchange, cardiac output, blood oxygen-carrying capacity, and tissue oxygen extraction. Reduction in oxygen delivery or higher oxygen consumption can initiate complex protective cellular processes precipitating oxygen debt. In critically ill and potentially surgical patients, stress and consequent hormonal or metabolic changes can trigger oxygen debt which is associated with worse morbidity and mortality. ⋯ Furthermore, large heterogeneity in clinical trials assessing outcomes benefit of increasing oxygen delivery limits our ability to recommend goal directed fluid therapy aimed at increasing cardiac ouput or higher FiO2. To understand and prevent oxygen debt in critically ill and surgical patients, we need to develop continuous monitoring techniques to assess the balance of oxygen delivery and consumption. Furthermore, methods of increasing oxygen delivery like goal-directed fluid therapy, higher FiO2 and anemia prevention should be rigorously evaluated with focus on establishing outcomes benefit.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewRisk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing?
Various risk stratification tools are used to predict patients' risk of adverse outcomes. Most of these tools are based on type of surgery and patient comorbidities. Accuracy of risk prediction is improved when additional factors such as functional capacity are included. ⋯ Technological advancement in data collection will likely improve existing risk assessment and allow development of new options. Future research should focus on establishing and standardizing perioperative outcomes that include meaningful patient-centric considerations such as quality of life. We review available stratification tools and important risk assessment biomarkers that address the most common causes of adverse outcomes.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewGeneral anesthetic techniques for enhanced recovery after surgery: Current controversies.
General anesthesia technique can influence not only immediate postoperative outcomes, but also long-term outcomes beyond hospital stay (e.g., readmission after discharge from hospital). There is lack of evidence regarding superiority of total intravenous anesthesia over inhalation anesthesia with regards to postoperative outcomes even in high-risk population including cancer patients. ⋯ Given that the residual effects of drugs used during anesthesia can increase postoperative morbidity and delay recovery, it is prudent to use a minimal number of drug combinations, and the drugs used are shorter-acting and administered at the lowest possible dose. It is imperative that the discerning anesthesiologist consider whether each drug used is really necessary for accomplishing perioperative goals.