Best practice & research. Clinical anaesthesiology
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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.
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Worldwide, the most performed surgical intervention is cesarean section. Hence, post-cesarean pain is a common problem with significant health and economic impact on the individual patient and society. ⋯ To facilitate recovery and temper the side effects of potent analgesic drugs such as opioids, multimodal analgesia is currently advocated, and clear international guidelines and recommendations have recently been described. In the present overview, we will discuss the most recent guidelines and evaluate various analgesic interventions.
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Best Pract Res Clin Anaesthesiol · May 2022
ReviewSpinal hypotension in obstetrics: Context-sensitive prevention and management.
Spinal hypotension during caesarean section remains a common complication, with important attendant maternal and fetal adverse outcomes. Research elucidating the mechanisms of spinal hypotension has led to the development and refinement of effective management strategies, with a particular emphasis on prophylactic vasopressor administration. This has proved effective in well-resourced settings, with maternal comfort and the elimination of nausea now considered the primary aim of treatment. ⋯ Translational, context-sensitive research in resource-limited settings has shown promise in implementing pragmatic strategies based on research from resource-rich environments. We review the current best practice for the prevention and treatment of spinal hypotension, with a special emphasis on effective strategies in resource-limited settings. We further suggest a research agenda to address the knowledge gap in specific contexts.
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In the developed world, cardiovascular disease has become the most frequent cause of death during pregnancy and postpartum, outnumbering by far obstetric causes of death such as bleeding or thromboembolism. Many factors contribute to this phenomenon, including an increasing age of pregnant women, co-morbidities, and an unhealthy lifestyle. ⋯ Profound knowledge of the cardiac pathophysiology is a prerequisite for the successful anaesthesiologic management of pregnant patients with cardiovascular disease. As there is no difference in general and regional anaesthesia regarding maternal outcomes, neuraxial anaesthesia using incremental techniques should be preferred for labour and (caesarean) delivery if not contraindicated by non-cardiac issues.