Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2022
ReviewThe role of tranexamic acid in the management of postpartum haemorrhage.
In the last decades, tranexamic acid (TXA) has emerged as an essential tool in blood loss management in obstetrics. TXA prophylaxis for postpartum haemorrhage (PPH) has been studied in double-blind, placebo-controlled, randomized clinical trials (RCTs). Given the small observed preventive effect, the systematic use of TXA for vaginal and/or caesarean deliveries remains controversial. ⋯ The TRACES in vivo analysis of biomarkers of TXA's antifibrinolytic effect have suggested that a dose of at least 1 g is required for the treatment of PPH. The TRACES pharmacokinetic model suggests that because TXA can be lost in the haemorrhaged blood, a second dose should be administered if the PPH continues or if severe coagulopathy occurs. Future pharmacodynamic analyses will focus on the appropriateness of TXA dosing regimens with regard to the intensity of fibrinolysis in catastrophic obstetric events.
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Best Pract Res Clin Anaesthesiol · Dec 2022
ReviewProtocol for postpartum haemorrhage including massive transfusion.
Postpartum haemorrhage (PPH) is one of the most common causes of maternal mortality worldwide. Management of PPH depends on the severity of bleeding. If the bleeding is severe, aorta compression can reduce bleeding. ⋯ During severe ongoing bleeding, haemostasis care includes early tranexamic acid, transfusion in ratio 4:4:1 (blood:plasma:platelets), and extra fibrinogen intravenously. If not severe PPH, use goal-directed therapy. During general anaesthesia and uterine atony, stop volatile anaesthesia and change to intravenous anaesthesia.
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Best Pract Res Clin Anaesthesiol · Aug 2022
ReviewBuilding a well-balanced culture in the perioperative setting.
Healthcare institutions are currently under enormous financial, political and social pressure. Especially in the perioperative setting, various professional groups with differing agendas, dynamic teams, high-stress levels and diverging stakeholder interests are contributing to tension on a variety of levels. ⋯ However, culture is a key factor in the search for optimal patient outcomes, quality of care, protection and long-time retention of staff, as well as economic success. In this review, we discuss important aspects to consider in building a great perioperative workplace, discuss indispensable adaptations in times of crisis and touch on urgently needed further investigations to optimize the art of developing, protecting, and cultivating a well-balanced culture.
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Best Pract Res Clin Anaesthesiol · Aug 2022
ReviewTechnical skills in the operating room: Implications for perioperative leadership and patient outcomes.
Today's effective leaders create opportunities for their teams to develop both technical and non-technical skills. In the perioperative arena, the focus until now mainly has been on improving non-technical skills, with only few studies analyzing the relationship between technical skills and patient outcomes. Technical competence requires assessment of one's own strengths and weaknesses, inclusion of deliberate goal-oriented practice, objective structured feedback assessment, and a focus on best practice and improved patient outcomes. In this article, we address the prerequisites, assessment, and implications of technical skills for perioperative leadership, and provide key metrics impacting patient outcomes and leadership development.
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Best Pract Res Clin Anaesthesiol · Aug 2022
ReviewManaging bottlenecks in the perioperative setting: Optimizing patient care and reducing costs.
Bottlenecks limit the maximum output of a system and indicate operational congestion points in process management. Bottlenecks also affect perioperative care and include dimensions such as infrastructure, architectural design and limitations, inefficient equipment and material supply chains, communication-related limitations on the flow of information, and patient- or staff-related factors. Improvement of workflow is, therefore, becoming a priority in most healthcare settings. We provide an overview of bottleneck management in the perioperative setting and introduce dimensions, including aligned strategic decision-making, tactical planning, and operational adjustments.