Current Opinion in Anesthesiology最新文献_第3页

Mitigating and preventing perioperative opioid-related harm. 减轻和预防围手术期阿片类药物相关伤害。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-08-09 DOI: 10.1097/ACO.0000000000001426

Monica W Harbell, Jonathan Cohen, Greg Balfanz, Emily Methangkool

{"title":"Mitigating and preventing perioperative opioid-related harm.","authors":"Monica W Harbell, Jonathan Cohen, Greg Balfanz, Emily Methangkool","doi":"10.1097/ACO.0000000000001426","DOIUrl":"10.1097/ACO.0000000000001426","url":null,"abstract":"Purpose of review: Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm.Recent findings: Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.g., pruritis, constipation, nausea) to potentially catastrophic (e.g. opioid-induced ventilatory impairment, respiratory depression, death). Overprescribing of opioids can lead to opioid diversion and drug driving. In this review, we will discuss opioid-related harm and what strategies can be used perioperatively to mitigate this harm. Interventions such as optimizing nonopioid analgesia, implementing Enhanced Recovery after Surgery programs, effective respiratory monitoring, patient education and opioid stewardship programs will be discussed.Summary: We will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"697-704"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156493","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}

引用次数: 0

Editorial introductions. 编辑介绍。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-31 DOI: 10.1097/ACO.0000000000001440

引用次数: 0

Depth of anesthesia monitoring: an argument for its use for patient safety. 麻醉深度监测：为患者安全使用麻醉深度监测的论据。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-02 DOI: 10.1097/ACO.0000000000001430

Karolina Brook, Aalok V Agarwala, Fenghua Li, Patrick L Purdon

{"title":"Depth of anesthesia monitoring: an argument for its use for patient safety.","authors":"Karolina Brook, Aalok V Agarwala, Fenghua Li, Patrick L Purdon","doi":"10.1097/ACO.0000000000001430","DOIUrl":"10.1097/ACO.0000000000001430","url":null,"abstract":"Purpose of review: There have been significant advancements in depth of anesthesia (DoA) technology. The Anesthesia Patient Safety Foundation recently published recommendations to use a DoA monitor in specific patient populations receiving general anesthesia. However, the universal use of DoA monitoring is not yet accepted. This review explores the current state of DoA monitors and their potential impact on patient safety.Recent findings: We reviewed the current evidence for using a DoA monitor and its potential role in preventing awareness and preserving brain health by decreasing the incidence of postoperative delirium and postoperative cognitive dysfunction or decline (POCD). We also explored the evidence for use of DoA monitors in improving postoperative clinical indicators such as organ dysfunction, mortality and length of stay. We discuss the use of DoA monitoring in the pediatric population, as well as highlight the current limitations of DoA monitoring and the path forward.Summary: There is evidence that DoA monitoring may decrease the incidence of awareness, postoperative delirium, POCD and improve several postoperative outcomes. In children, DoA monitoring may decrease the incidence of awareness and emergence delirium, but long-term effects are unknown. While there are key limitations to DoA monitoring technology, we argue that DoA monitoring shows great promise in improving patient safety in most, if not all anesthetic populations.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"689-696"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156539","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}

引用次数: 0

Machine learning: implications and applications for ambulatory anesthesia. 机器学习：对非住院麻醉的影响和应用。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-07-08 DOI: 10.1097/ACO.0000000000001410

Karisa Anand, Suk Hong, Kapil Anand, Joseph Hendrix

{"title":"Machine learning: implications and applications for ambulatory anesthesia.","authors":"Karisa Anand, Suk Hong, Kapil Anand, Joseph Hendrix","doi":"10.1097/ACO.0000000000001410","DOIUrl":"10.1097/ACO.0000000000001410","url":null,"abstract":"Purpose of review: This review explores the timely and relevant applications of machine learning in ambulatory anesthesia, focusing on its potential to optimize operational efficiency, personalize risk assessment, and enhance patient care.Recent findings: Machine learning models have demonstrated the ability to accurately forecast case durations, Post-Anesthesia Care Unit (PACU) lengths of stay, and risk of hospital transfers based on preoperative patient and procedural factors. These models can inform case scheduling, resource allocation, and preoperative evaluation. Additionally, machine learning can standardize assessments, predict outcomes, improve handoff communication, and enrich patient education.Summary: Machine learning has the potential to revolutionize ambulatory anesthesia practice by optimizing efficiency, personalizing care, and improving quality and safety. However, limitations such as algorithmic opacity, data biases, reproducibility issues, and adoption barriers must be addressed through transparent, participatory design principles and ongoing validation to ensure responsible innovation and incremental adoption.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"619-623"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560186","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}

引用次数: 0

Beyond adverse events in anesthesiology: 'unanticipated events' and strategies for improved reporting. 麻醉学不良事件之外："意外事件 "和改进报告的策略。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-08-09 DOI: 10.1097/ACO.0000000000001425

Karolina Brook, Molly Wilde, Andrea Vannucci, Aalok V Agarwala

{"title":"Beyond adverse events in anesthesiology: 'unanticipated events' and strategies for improved reporting.","authors":"Karolina Brook, Molly Wilde, Andrea Vannucci, Aalok V Agarwala","doi":"10.1097/ACO.0000000000001425","DOIUrl":"10.1097/ACO.0000000000001425","url":null,"abstract":"Purpose of review: Patient safety in anesthesiology has advanced significantly over the past several decades. The current process of improving care is often based on studying adverse events (AEs) and near misses. However, there is a wealth of information not captured by focusing solely on these events, potentially resulting in missed opportunities for care improvements.Recent findings: We review terms such as AEs and nonroutine events (NREs), and introduce the concept of unanticipated events (UEs), defined as events that deviate from intended care that may/may not have been caused by error, may/may not be preventable, and may/may not have caused injury to a patient. UEs incorporate AEs in addition to many other anesthetic events not routinely tracked, allowing for trend analysis over time and the identification of additional opportunities for quality improvement. We review both automated and self-reporting tools that currently exist to capture this often-neglected wealth of data. Finally, we discuss the responsibility of quality/safety leaders for data monitoring.Summary: Consistent reporting and monitoring for trends related to UEs could allow departments to identify risks and mitigate harm before it occurs. We review various proposed methods to expand data collection, and recommend anesthesia practices pursue UE tracking through department-specific reporting interfaces.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"727-735"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156538","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}

引用次数: 0

Harnessing innovation to improve patient safety in anesthesiology. 利用创新改善麻醉科患者安全。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-31 DOI: 10.1097/ACO.0000000000001415

Monica W Harbell

引用次数: 0

Ambulatory anesthesia: beyond the operating room. 非住院麻醉：手术室之外。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-31 DOI: 10.1097/ACO.0000000000001436

Niraja Rajan

引用次数: 0

Spinal anesthesia in ambulatory patients. 流动病人的脊髓麻醉。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-07-09 DOI: 10.1097/ACO.0000000000001412

Ignacio Ledesma, Andrea Stieger, Markus M Luedi, Carolina S Romero

{"title":"Spinal anesthesia in ambulatory patients.","authors":"Ignacio Ledesma, Andrea Stieger, Markus M Luedi, Carolina S Romero","doi":"10.1097/ACO.0000000000001412","DOIUrl":"10.1097/ACO.0000000000001412","url":null,"abstract":"Purpose of review: To assess current practice in the use of spinal anesthesia in major ambulatory surgery, highlighting its advantages over general anesthesia and identifying potential areas for improvement to facilitate a transition to a sustainable healthcare system.Recent findings: Spinal anesthesia might be preferred in selected populations when compared to general anesthesia providing the highest standards of healthcare quality.The use of local anesthetics with short half-life has proven to be efficient in achieving high anesthesia success rates. Spinal anesthesia does not increase perioperative complications; instead, it has shown a reduction in postoperative nausea and vomiting, an improvement in patient comfort, and a favorable economic impact when compared to general anesthesia.Summary: Spinal anesthesia is an appropriate method for anesthesia in ambulatory patients, offering advantages over general anesthesia in selected populations.The use of spinal anesthesia is expanding to meet surgical needs. Therefore, it is crucial to plan ahead and anticipate organizational failures in the ambulatory setting to maintain safety and efficiency during outpatient procedures and surgeries.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"661-665"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560187","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}

引用次数: 0

The role of human factors engineering in patient safety. 人因工程在患者安全中的作用。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-18 DOI: 10.1097/ACO.0000000000001437

Lilibeth Fermin, Lauren Lobaugh, K Gage Parr, Morgan Currie

引用次数: 0

The electronic health record: does it enhance or distract from patient safety? 电子病历：是加强了患者安全，还是分散了患者安全？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-02 DOI: 10.1097/ACO.0000000000001429

George Tewfik, Steven Rivoli, Emily Methangkool

引用次数: 0