Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewThe future of recovery - Integrated, digitalised and in real time.
Traditional perioperative risk prediction recovery identifies patient populations at risk of suboptimal recovery but not individual patients in whom this actually occurs and in whom timely intervention is beneficial. Patient-focused recovery emphasises a return to a semblance of normality and an ability to perform activities previously undertaken. ⋯ Real-time recovery (RTR) assessment is the contemporaneous collection, analysis and reporting of data that enable the identification of suboptimal recovery in individual patients in a timeframe that minimises the delay in the implementation of the targeted treatment. There is a need to validate the clinical utility of existing biometric technology, wireless hybrid devices and digitalised platforms in providing both clinician and patient with RTR data and to determine the effect, if any, that RTR has on patient engagement and outcome.
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewIntegration of satisfaction and quality of recovery.
Among patient-reported outcomes, patient satisfaction and quality of recovery are key measures of patient-centred care. The measurement of patient satisfaction should use validated, multidimensional scales. There are general scales that aim to evaluate the entire perioperative period and scales focused on specific periods (post-operative) or techniques (loco-regional anaesthesia). ⋯ Improving patient satisfaction goes beyond quality improvement. In a large database, the highest satisfaction was associated with the lowest morbidity and mortality. Thus, it is likely that the process of improving quality changes multiple components of medical management, hence improving several patient outcomes.
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Best Pract Res Clin Anaesthesiol · Sep 2018
ReviewA matter of perspective - Objective versus subjective outcomes in the assessment of quality of recovery.
Current post-operative recovery assessment exists as a dichotomy, maintaining objectivity whilst providing relevance to patient-centred care. Both objective and subjective measures are utilised in modern recovery assessment and are best viewed as complimentary. ⋯ Patient-reported outcomes prioritise the patient's perspective of symptoms and care, which are the most important aspects at the time of assessment but are limited by their susceptibility to response shift and recall bias. Ideally, quality of recovery is assessed using objective measures in concert with measures of clinical complexity and in parallel with patient-reported outcomes.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewUpdate on nitrous oxide and its use in anesthesia practice.
Nitrous oxide (N2O) is an anesthetic and analgesic gas with a long history of medical applications. It acts on multiple supraspinal and spinal targets and has utility in a wide range of clinical situations. The relative safety, low incidence, and acuity of adverse effects of N2O, along with the ability to be administered by trained medical providers with varying clinical backgrounds, as well as self-administered by patients, assure its persistent and expanding role in clinical practice.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewPharmacogenomics, precision medicine, and implications for anesthesia care.
The study of how individual genetic differences, known as polymorphisms, change the pharmacokinetics and pharmacodynamics of drugs is called pharmacogenomics. As the field of pharmacogenetics grows and continues to identify genetic polymorphisms, it is promising that the unmet need in this patient population may soon be addressed with personalized drug therapy based on the patient's genetic composition. ⋯ This manuscript describes the current state of precision medicine as it relates to perioperative care and how preoperative genomic analysis can help improve patient outcomes. This investigation also outlines future directions in this important and evolving field.