Advances in anesthesia education: increasing access and collaboration in medical education, from E-learning to telesimulation
Purpose of review
The landscape of medical education continues to evolve. Educators and learners must stay informed on current medical literature, in addition to focusing efforts on current educational trends and evidence-based methods. The present review summarizes recent advancements in anesthesiology education, specifically highlighting trends in e-learning and telesimulation, and identifies possible future directions for the field.
Recent findings
Websites and online platforms continue to be a primary source of educational content; top websites are more likely to utilize standardized editorial processes. Podcasts ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research
Maternal safety: recent advances and implications for the obstetric anesthesiologist
This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists.
Recent findings
Cardiovascular and other chronic medical conditions contribute to an increasing number of maternal deaths. Anesthetic complications associated with general anesthesia are decreasing, but complications associated with neuraxial techniques persist. Obstetric early warning systems are evolving and hold promise in identifying women at risk for adverse intrapartum events. Postpartum hemorrhage rates are rising, and rigorous evaluation of existing protocols may reveal unrecognized deficienc...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research
Automation failures and patient safety
Purpose of review
The goal of automation is to decrease the anesthesiologist's workload and to decrease the possibility of human error. Automated systems introduce problems of its own, however, including loss of situation awareness, leaving the physician out of the loop, and training physicians how to monitor autonomous systems. This review will discuss the growing role of automated systems in healthcare and describe two types of automation failures.
Recent findings
An automation surprise occurs when an automated system takes an action that is unexpected by the user. Mode confusion occurs when the operator does not un...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research
Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology
Purpose of review
The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia.
Recent findings
For cardiac output (CO) monitoring, bolus thermodilution is still considered the go...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research
Advances in airway management and mechanical ventilation in inhalation injury
Purpose of review
Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions.
Recent findings
Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscop...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research
Patient-reported outcomes for ambulatory surgery
Purpose of review
To discuss the importance of validated tools that measure patient-reported outcomes and their use in ambulatory surgery.
Recent findings
Sustained increases in ambulatory surgical care reflect advances in surgical techniques and perioperative anaesthetic care. Use of patient-reported outcomes allows identification of minor adverse events that are more common in this population compared with traditional endpoints such as mortality. Variability in reported outcomes restricts research potential and limits the ability to benchmark providers. The standardized endpoints in perioperative medicine initiative...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Peripheral nerve blockade and novel analgesic modalities for ambulatory anesthesia
Purpose of review
Despite peripheral nerve blockade offering analgesic benefits and improving patient satisfaction, it has not been well adopted in ambulatory anesthesia. In this review, we aim to summarize the evidence underlying peripheral nerve blockade, local anesthetic adjuncts, continuous peripheral nerve blockade and novel analgesic modalities, with the objective to provide recommendations on postoperative analgesia optimization after peripheral nerve blockade in an ambulatory setting.
Recent findings
Barriers to the widespread use of peripheral nerve blockade in ambulatory anesthesia could include lack of educ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Procedure-specific and patient-specific pain management for ambulatory surgery with emphasis on the opioid crisis
Purpose of review
Postoperative pain is frequent while, on the other hand, there is a grooving general concern on using effective opioid pain killers in view of the opioid crisis and significant incidence of opioid abuse. The present review aims at describing nonopioid measures in order to optimize and tailor perioperative pain management in ambulatory surgery.
Recent findings
Postoperative pain should be addressed both preoperatively, intraoperatively and postoperatively. The management should basically be multimodal, nonopioid and procedure-specific. Opioids should only be used when needed on top of multimodal nonop...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Spinal anesthesia for ambulatory surgery: current controversies and concerns
Purpose of review
General anesthesia is a popular choice for ambulatory surgery. Spinal anesthesia is often avoided because of perceived delays due to time required to administer it and prolonged onset, as well as concerns of delayed offset, which may delay recovery and discharge home. However, the reports of improved outcomes in hospitalized patients undergoing total joint arthroplasty have renewed the interest in spinal anesthesia. This review article critically assesses the role of spinal anesthesia in comparison with fast-track general anesthesia for the outpatient setting.
Recent findings
The purported benefits o...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Nulla Per Os (NPO) guidelines: time to revisit?
Purpose of review
Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed.
Recent findings
Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoperati...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Preoperative assessment and optimization of cognitive dysfunction and frailty in the ambulatory surgical patient
Purpose of review
The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the asses...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
The high-risk patient for ambulatory surgery
This article describes the processes for identifying high-risk patients at the time of ambulatory procedure scheduling, enabling the implementation of multidisciplinary collaborative pathways for prehabilitation and optimization, allowing for risk mitigation and improvement in outcomes. This review is particularly relevant because of the current proliferation of ambulatory surgery with more complex procedures being performed on an outpatient basis on patients who may be American Society of Anesthesiologists Physical Status 3 or greater.
Recent findings
Increased longevity and rising prevalence of obesity have resulted i...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
High-risk surgical procedures and semi-emergent surgical procedures for ambulatory surgery
Purpose of review
This review evaluates more complex surgical procedures to see whether they might be suitable for ambulatory surgery. Operations that have shown an increasing daycase rate in England include thyroidectomy, joint arthroplasty, spinal surgery and hysterectomy, and these procedures are evaluated. Similarly, there have been recent developments in the management of nonelective ambulatory surgery with more timely throughput and home discharge for suitable patients.
Recent findings
Caveats on patient selection with the development of focussed educational programmes about the proposed operation have assisted ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Enhanced recovery pathways for ambulatory surgery
Purpose of review
Implementation of enhanced recovery pathways have allowed migration of complex surgical procedures from inpatient setting to the outpatient setting. These programs improve patient safety and patient-reported outcomes. The present article discusses the principles of enhanced recovery pathways in adults undergoing ambulatory surgery with an aim of improving patient safety and postoperative outcomes.
Recent findings
Procedure and patient selection is one of the key elements that influences perioperative outcomes after ambulatory surgery. Other elements include optimization of comorbid conditions, patien...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
