Best Practice & Research-Clinical Anaesthesiology最新文献

{"title":"Emergency ambulatory surgery: Can it work?","authors":"Mark Skues (Retired Consultant Anaesthetist)","doi":"10.1016/j.bpa.2023.03.003","DOIUrl":"https://doi.org/10.1016/j.bpa.2023.03.003","url":null,"abstract":"<div><p>Ambulatory surgery has been shown to be a management regimen associated with high quality of care and patient satisfaction. Recent research has suggested that some facets of emergency care could similarly be improved by earlier senior face-to-face consultation, a reduced time awaiting a surgical procedure and a ‘fast track’ recovery process.</p><p>This review aims to provide information regarding the pathway of emergency ambulatory surgery and the typical changes required to optimise the process, whereby patients receive non-elective care in the most efficient way. While the concept may obviously not be suitable for all emergency care, the literature suggests that some procedures may benefit from optimisation of care, with a shortening of stay. To this end, within the United Kingdom, the National Health Service has developed a roll out of ‘Same Day Emergency Care’ using an established network of hospitals to deliver multi-disciplinary teamwork and further the concept of shorter stays in the hospital domain.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 387-395"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198450","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":"COVID-19 infection and ambulatory surgery: Decision making based on known knowns","authors":"Leopoldo Vicente Rodriguez M.D., M.B.A., F.A.A.P., FASA, SAMBA-F (Anesthesiology and Perioperative Medicine Consultant, Chair, Member, Past-President, Assistant Professor of Anesthesiology) ,&nbsp;Joshua Aaron Bloomstone MD, MSc, FASA, SSGB (Clinical Professor of Anesthesiology, (Hons) Associate Professor of Surgery)","doi":"10.1016/j.bpa.2022.12.002","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.12.002","url":null,"abstract":"<div><p>During the spring of 2020, as Coronavirus Disease 2019 (COVID-19) infections rapidly spread across the globe, all sectors of healthcare, everywhere, would change in ways that were unimaginable. Early on, the ambulatory surgery space, being no exception, would suffer deep and impactful reductions in patient volume and revenue. Though actual care stoppages were short-lived, decreased ambulatory surgical patient volumes continued for a myriad of reasons, though in some cases, ambulatory surgery centers (ASCs) provided surgical care in limited numbers to patients who were “offloaded” from inpatient lists.</p><p>Released on March 24, 2020, herein, we address the key perioperative issues as they relate to COVID-19 and ambulatory surgery including the many complexities and challenges of a new and rapidly changing virus, the impact of viral infection and vaccine development on perioperative outcomes, key ambulatory surgical approaches to COVID-19-related patient and staff safety, and finally, managing issues related to both supply chain (personal protective equipment (PPE) and other necessary equipment) and facility staffing.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 305-315"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198415","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":"Day-surgery adult patients with obesity and obstructive sleep apnea: Current controversies and concerns","authors":"Omaira Azizad MD, FASA ,&nbsp;Girish P. Joshi MB BS, MD, FFARCSI","doi":"10.1016/j.bpa.2022.11.004","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.11.004","url":null,"abstract":"<div><p><span>Obesity and obstructive sleep apnea are considered independent risk factors that can adversely affect perioperative outcomes. A combination of these two conditions in the </span>ambulatory surgery patient can pose significant challenges for the anesthesiologist. Nevertheless, these patients should not routinely be denied access to ambulatory surgery. Instead, patients should be appropriately optimized. Anesthesiologists and surgeons must work together to implement fast-track anesthetic and surgical techniques that will ensure successful ambulatory outcomes.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 317-330"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198414","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":"Patient selection in ambulatory surgery","authors":"John A. Hodgson (MD, Associate Professor) ,&nbsp;Kyle L. Cyr (MD, Assistant Professor) ,&nbsp;BobbieJean Sweitzer (MD, FACP, SAMBA-F, FASA, Professor)","doi":"10.1016/j.bpa.2022.12.005","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.12.005","url":null,"abstract":"<div><p>Patient selection is important for ambulatory surgical practices. Proper patient selection for ambulatory practices will optimize resources and lead to increased patient and provider satisfaction. As the number and complexity of procedures in ambulatory surgical centers increase, it is important to ensure that patients are best cared for in facilities that can provide appropriate levels of care. This review addresses the multiple variables and resources that should be considered when selecting patients for anesthesia in ambulatory centers and offices.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 357-372"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198421","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":"Adjuvants for balanced anesthesia in ambulatory surgery","authors":"Marc Coppens MD, PhD ,&nbsp;Annelien Steenhout MD ,&nbsp;Luc De Baerdemaeker MD, PhD","doi":"10.1016/j.bpa.2022.12.003","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.12.003","url":null,"abstract":"<div><p><span><span><span>Balanced anesthesia relies on the simultaneous administration of different </span>drugs<span> to attain an anesthetic state. The classic triad of anesthesia is a combination of a hypnotic, an analgesic, and a </span></span>neuromuscular blocker<span>. It is predominantly the analgesic pillar of this triad that became more and more supported by adjuvant therapy. The aim of this approach is to evolve into an opioid-sparing technique to cope with undesirable side effects of the opioids and is fueled by the opioid epidemic. The optimal strategy for balanced general anesthesia in </span></span>ambulatory surgery<span><span> must aim for a transition to a multimodal analgesic regimen dealing with acute postoperative pain and ideally reduce the most common adverse effects patients are faced with at home; sore throat, </span>delayed awakening, memory disturbances, headache, nausea and vomiting, and negative behavioral changes. Over the years, this continuum of “multimodal general anesthesia” adopted many drugs with different modes of action. This review focuses on the most recent evidence on the different adjuvants that entered clinical practice and gives an overview of the different mechanisms of action, the potential as opioid-sparing or hypnotic-sparing drugs, and the applicability specifically in ambulatory surgery.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 409-420"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198423","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":"Benchmarking outcomes for day surgery","authors":"Leopoldo Vicente Rodriguez (Assitant Professor of Anesthesiology) ,&nbsp;Joshua Aaron Bloomstone ((Hons) Associate Professor of Surgery)","doi":"10.1016/j.bpa.2023.03.001","DOIUrl":"https://doi.org/10.1016/j.bpa.2023.03.001","url":null,"abstract":"<div><p>In comparison to large acute care centers, Ambulatory Surgery Centers (ASCs) provide patient-centered, fast, efficient, effective, high-value, high-quality, reliable, and safe care. For these reasons, ASCs are often preferred working venues for perioperative staff and desirable partners for surgeons, proceduralists, and anesthesiologists. Given today's many headwinds, including inflation, downward rate pressures, increasing regulation, and near constant supply chain issues, not to mention increasing patient and procedural complexity, exemplary clinical and operational management is of paramount importance and requires frequent measurement and benchmarking. Benchmarking is critical to performance assessment and is vital for assessing existing processes and new pathways and protocols, and remains the best way to identify areas for improvement. This chapter provides the reader with an overview of key ASC-related performance indicators, what they mean, and how best to measure and compare them to local, regional, and national benchmarks.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 331-342"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198413","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":"Spinal sonography and central neuraxial blocks","authors":"Ranjith Kumar Sivakumar (Visiting Scholar and Research Fellow),&nbsp;Manoj Kumar Karmakar Professor","doi":"10.1016/j.bpa.2023.04.008","DOIUrl":"10.1016/j.bpa.2023.04.008","url":null,"abstract":"<div><p><span><span>Central neuraxial blocks (CNBs), which include spinal, epidural, and combined spinal epidural injections, are indispensable techniques in the anesthesiologist's armamentarium. Indeed, in scenarios such as when dealing with the </span>obstetric<span><span> population, patients with obesity, or patients having respiratory compromise (e.g., lung disease or scoliosis), CNBs are the mainstay for anesthesia and/or analgesia. Traditionally, CNBs are performed using anatomical landmarks, which are simple, easy to master, and exceptionally successful in most cases. Nevertheless, there are notable limitations with this approach, especially in scenarios where CNBs are considered mandatory and vital. Any limitation of an anatomic landmark-based approach is an opportunity for an ultrasound-guided (USG) technique. This has become particularly true for CNBs, where recent advances in </span>ultrasound technology and research data have addressed many of the shortcomings of the traditional anatomic landmark-based approaches. This article reviews the </span></span>ultrasound imaging<span> of the lumbosacral spine and its application for CNBs.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 209-242"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9654299","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":"Spinal anaesthesia in children: A narrative review","authors":"Per-Arne Lönnqvist (Professor)","doi":"10.1016/j.bpa.2023.01.002","DOIUrl":"10.1016/j.bpa.2023.01.002","url":null,"abstract":"<div><p>Spinal anaesthesia is an established and frequently used anaesthetic technique in adults. However, this versatile regional anaesthetic technique is less frequently used in paediatric anaesthesia even though it can be used for minor (e.g. inguinal hernia repair) and major (e.g. cardiac surgery) surgical procedures. The aim of this narrative review was to summarize the current literature with regard to technical aspects, surgical context, choice of drugs, potential complications, as well as the effects of the neuroendocrine surgical stress response and potential long-term effects of anaesthesia during infancy. In summary, spinal anaesthesia represents a valid alternative in the paediatric anaesthesia setting also.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 133-138"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652347","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":"Continuous spinal technique in surgery and obstetrics","authors":"Chandra Mohan Kumar (Visiting Consultant in Anaesthesia, Visiting Professor) ,&nbsp;Edwin Seet (Adjunct Associate Professor and Senior Consultant in Anaesthesia)","doi":"10.1016/j.bpa.2023.02.007","DOIUrl":"10.1016/j.bpa.2023.02.007","url":null,"abstract":"<div><p><span>Continuous Spinal Anaesthesia (CSA) technique has all the advantages of single-shot spinal anaesthesia with the added benefit of prolonging the duration of anaesthesia. CSA has been used as a primary method of anaesthesia as an alternative to </span>general anaesthesia<span><span> in high-risk and elderly patients for various elective and emergency surgical procedures<span><span> involving the abdomen, lower limbs, and vascular surgeries. CSA has also been used in some </span>obstetrics units. Despite its advantages, CSA technique remains underutilised because it is surrounded with myths, mysteries, and controversies concerning neurological, other morbidities and minor technical difficulties. This article includes a description of CSA technique compared to other contemporary central neuraxial blocks. It also discusses the perioperative applications of CSA for different surgical and </span></span>obstetrics procedures, advantages, disadvantages, complications, problems, and pointers on how to perform the technique safely.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 139-156"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9646059","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":"Intrathecal opioids for the management of post-operative pain","authors":"Narinder Rawal (Professor)","doi":"10.1016/j.bpa.2023.01.001","DOIUrl":"10.1016/j.bpa.2023.01.001","url":null,"abstract":"<div><p>Intrathecal opioids are highly effective in the management of post-operative pain. The technique is simple with a very low risk of technical failure or complications, and it does not require additional training or expensive equipment such as ultrasound machines and, therefore, is widely practised around the world. The high-quality pain relief is not associated with sensory, motor or autonomic deficits. This study focuses on intrathecal morphine (ITM) which is the only US Food and Drug Administration-approved opioid for intrathecal administration and remains the most commonly used as well as extensively studied. The use of ITM is associated with prolonged analgesia lasting 20–48 h after a variety of surgical procedures. ITM has a well-established role in thoracic, abdominal, spinal, urological and orthopaedic surgeries. It is considered the ‘gold standard’ analgesia technique for caesarean delivery which is generally performed under spinal anaesthesia. As the role of epidural technique in post-operative pain management continues to decrease, ITM has emerged as the neuraxial technique of choice for pain management after a major surgery as a component of multimodal analgesia in Enhanced Recovery After Surgery (ERAS) protocols. ITM is recommended by many scientific groups and societies such as ERAS, PROSPECT, the National Institute for Health and Care Excellence and the Society of Obstetric Anesthesiology and Perinatology. The doses of ITM have decreased successively; today they are a fraction of those used in the early 1980s. With these dose reductions, the risks have decreased; current evidence shows that the risk of the much-feared respiratory depression with low-dose ITM (up to 150 mcg) is no greater than that with systemic opioids used in routine clinical practice. Patients receiving low-dose ITM can be nursed in regular surgical wards. The monitoring recommendations from societies such as the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the American Society of Regional Anesthesia and Pain Medicine and the American Society of Anesthesiologists need to be updated so that the requirements for extended or continuous monitoring at postoperative care units (PACUs), step-down units, high-dependency units, and intensive care units can be eliminated, thereby reducing additional costs and inconvenience and making this simple, versatile and highly effective analgesia technique available to a wider patient population in resource-limited settings.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 123-132"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652346","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}