Best Practice & Research-Clinical Anaesthesiology最新文献

{"title":"Patient blood management","authors":"Lachlan F. Miles","doi":"10.1016/j.bpa.2024.01.001","DOIUrl":"10.1016/j.bpa.2024.01.001","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 437-438"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143234789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative anaemia: Hiding in plain sight","authors":"Ethan H. Crispell ,&nbsp;Jessica Trinh ,&nbsp;Matthew A. Warner","doi":"10.1016/j.bpa.2023.11.002","DOIUrl":"10.1016/j.bpa.2023.11.002","url":null,"abstract":"<div><div><span>Postoperative anaemia is common among surgical patients. While often viewed as a benign condition, postoperative anaemia is neither inevitable nor harmless, being intricately linked with adverse outcomes. In this review, we summarize the prevalence, aetiology, and outcomes of postoperative anaemia and highlight prevention and management strategies. Further, we propose a novel framework to characterize postoperative anaemia as an acute organ injury (i.e., acute blood injury, anaemic subtype), thereby drawing attention to a condition that is frequently overlooked. Additionally, we discuss areas warranting further research, including </span>risk stratification for patients at heightened risk for the development of postoperative anaemia and associated complications and determination of appropriate treatment strategies.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 486-494"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135615521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does patient blood management represent good value for money?","authors":"Adam Irving ,&nbsp;Zoe K. McQuilten","doi":"10.1016/j.bpa.2023.11.004","DOIUrl":"10.1016/j.bpa.2023.11.004","url":null,"abstract":"<div><div>Patient blood management is the umbrella term for a suite of initiatives designed to optimise blood product usage, minimise transfusion needs, and ensure appropriate and evidence-based transfusion practices. In this review we summarise published economic evaluations of patient blood management to determine whether they represent good value for money. We identified 54 economic evaluations of patient blood management, the majority of which had positive cost-effectiveness conclusions. In particular, anaemia management with ferric carboxymaltose, adopting a restrictive transfusion strategy, and the administration of tranexamic acid appear likely to be highly cost effective. Intraoperative cell salvage may be cost effective if used in patients at high risk of bleeding. Overall, patient blood management programmes are likely to reduce costs and improve patient outcomes in a wide range of patient populations. No identified evaluations included an assessment of the impact of patient blood management on preserving the blood supply.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 511-518"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135670225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The patient with congenital heart disease in ambulatory surgery","authors":"Gert-Jan Eerdekens (MD, Anesthesia Consultant) ,&nbsp;Dieter Van Beersel (MD, PhD-Student, Anesthesia Consultant) ,&nbsp;Steffen Rex (MD, PhD, Associate Professor, Head of the Anesthesia Department) ,&nbsp;Marc Gewillig (MD, PhD, Professor, Pediatric Cardiologist) ,&nbsp;An Schrijvers (MD, Anesthesia Consultant) ,&nbsp;Layth AL tmimi (MD, PhD, Associate Professor, Anesthesia Consultant)","doi":"10.1016/j.bpa.2022.11.006","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.11.006","url":null,"abstract":"<div><p><span>The number of patients with congenital heart disease (CHD) undergoing </span>ambulatory surgery<span> is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists’ Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator.</span></p><p>Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 421-436"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total joint replacement in ambulatory surgery","authors":"Jaime L. Baratta (Associate Professor of Anesthesiology and Perioperative Medicine) ,&nbsp;Brittany Deiling (Assistant Professor of Anesthesiology) ,&nbsp;Yasser R. Hassan (Instructor of Anesthesiology and Perioperative Medicine) ,&nbsp;Eric S. Schwenk (Professor of Anesthesiology and Perioperative Medicine)","doi":"10.1016/j.bpa.2023.03.005","DOIUrl":"https://doi.org/10.1016/j.bpa.2023.03.005","url":null,"abstract":"<div><p>Total joint arthroplasty<span> is one of the most commonly performed surgical procedures in the United States, and projected numbers are expected to double in the next ten years. From 2018 to 2020, total hip and knee arthroplasty were removed from the United States’ Center for Medicare and Medicaid Services “inpatient-only” list, accelerating this migration to the ambulatory setting. Appropriate patient selection, including age, body mass index<span><span>, comorbidities, and adequate social support, is critical for successful ambulatory total joint arthroplasty. General anesthesia<span> and neuraxial anesthesia are both safe and effective anesthetic choices, and recent studies in this population have found no difference in outcomes. Multimodal analgesia, including </span></span>acetaminophen<span>, nonsteroidal anti-inflammatory drugs, local infiltration analgesia, and peripheral nerve blocks<span>, is the foundation for adequate pain control. Common reasons for “failure to launch” include postoperative urinary retention<span>, postoperative nausea and vomiting, inadequate analgesia, and hypotension.</span></span></span></span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 269-284"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthesia for ambulatory surgery","authors":"An Teunkens (Kliniekhoofd Anesthesie),&nbsp;A. Valedon (Consultant Anaesthesist)","doi":"10.1016/j.bpa.2023.05.001","DOIUrl":"https://doi.org/10.1016/j.bpa.2023.05.001","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 267-268"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of ambulatory surgery for geriatric patients","authors":"Mary Ann Vann MD, FASA (Assistant Professor)","doi":"10.1016/j.bpa.2022.12.004","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.12.004","url":null,"abstract":"<div><p>The elderly segment of the population is growing rapidly worldwide. Older patients comprise a disproportionate percentage of the surgical caseload. Physiological changes are inevitable with aging; some may impact a patient’s response to anesthesia and surgery. Careful evaluation of an elderly patient preoperatively is vital to proper patient selection for ambulatory surgeries<span>, particularly for complex and lengthy procedures. Cognitive issues, frailty<span>, and geriatric syndromes make a patient vulnerable and sometimes unsuitable for certain ambulatory procedures. Preoperative planning and interventions may improve outcomes for the elderly patient undergoing ambulatory surgery.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 343-355"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional anaesthesia for ambulatory surgery","authors":"Kristof Nijs MD ,&nbsp;Joke Ruette MD ,&nbsp;Marc Van de Velde MD, PhD, EDRA, FESAIC (Professor) ,&nbsp;Björn Stessel MD, PhD (Professor)","doi":"10.1016/j.bpa.2022.12.001","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.12.001","url":null,"abstract":"<div><p><span>Regional anaesthesia (RA) has an important and ever-expanding role in </span>ambulatory surgery<span><span><span>. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available </span>local anaesthetics<span> limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of </span></span>regional anaesthetics<span><span> continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural </span>dexamethasone gives the longest and most optimal sensory block.</span></span></p><p><span>In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia </span>drugs<span><span> and adjuvants, paediatric RA in </span>ambulatory care and discuss the impact of RA by COVID-19.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 397-408"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diabetes patient for ambulatory surgery","authors":"Mary Ann Vann MD FASA (Assistant Professor)","doi":"10.1016/j.bpa.2023.03.002","DOIUrl":"https://doi.org/10.1016/j.bpa.2023.03.002","url":null,"abstract":"<div><p>Perioperative management of blood glucose is vital to the recovery and return to normal life for patients with diabetes undergoing ambulatory surgery<span><span>. Important aspects of the preoperative assessment include the evaluation of the patient's usual level of control and self-management skills and the occurrence of hypoglycemia. There are disputes on the perioperative administration of diabetes medications, insulin, and certain other </span>drugs<span>. This article will provide information on current recommendations for ambulatory surgery and anesthesia for diabetic patients. It will address controversies and reemphasize important points of optimal care. New drugs and technologies for diabetes patients that may impact the perioperative period will be described.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 373-385"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced recovery protocols for ambulatory surgery","authors":"Daniel S. Cukierman (Postdoctoral fellow) ,&nbsp;Juan P. Cata (Associate Professor) ,&nbsp;Tong Joo Gan (Professor)","doi":"10.1016/j.bpa.2023.04.007","DOIUrl":"https://doi.org/10.1016/j.bpa.2023.04.007","url":null,"abstract":"<div><h3>Introduction</h3><p><span>In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (</span><span>https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf</span><svg><path></path></svg><span><span><span><span>). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in </span>ambulatory centers. However, more complex surgical interventions, such as </span>sleeve gastrectomies, oncological, and spine surgeries, and even </span>arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2–5)</span></p><p>The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (<span>https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/</span><svg><path></path></svg><span>). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23 h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6)</span></p><p>To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices.</p><p><span>The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving </span>postoperative nausea and vomiting (PONV) and pain control. (7)</p><p>This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 285-303"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}