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Best Practice & Research. Clinical Anaesthesiology

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https://read.qxmd.com/read/30522721/cognitive-self-assessment-scales-in-surgical-settings-acceptability-and-feasibility
#1
REVIEW
N Stoicea, K N Koehler, D W Scharre, S D Bergese
Pre-existing cognitive impairment is associated with poor surgical outcomes, long hospital stays, and increased morbidity and mortality. This necessitates the use of screening tools to evaluate preoperative cognitive status in elderly surgical patients. Given the growing population of older adults and increased prevalence of cognitive impairment, it is necessary to investigate whether staff-administered or self-administered cognitive screening examinations provide more sensitive information about pre-existing (preoperative) cognitive status...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522720/the-future-of-recovery-integrated-digitalised-and-in-real-time
#2
REVIEW
Andrea Bowyer, Colin Royse
Traditional perioperative risk prediction recovery identifies patient populations at risk of suboptimal recovery but not individual patients in whom this actually occurs and in whom timely intervention is beneficial. Patient-focused recovery emphasises a return to a semblance of normality and an ability to perform activities previously undertaken. A patient's sense of self-efficacy and engagement in their own care positively influences functional improvement and emotive recovery. The future of recovery assessment is that which is individualised, digitalised, integrated and in real time...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522719/a-matter-of-perspective-objective-versus-subjective-outcomes-in-the-assessment-of-quality-of-recovery
#3
REVIEW
Andrea Bowyer, Colin Royse
Current post-operative recovery assessment exists as a dichotomy, maintaining objectivity whilst providing relevance to patient-centred care. Both objective and subjective measures are utilised in modern recovery assessment and are best viewed as complimentary. At institutional and provider levels, performance indicators are utilised as surrogates for quality of recovery but only if these indicators are assessed in the clinical context from which they are derived. Patient-reported outcomes prioritise the patient's perspective of symptoms and care, which are the most important aspects at the time of assessment but are limited by their susceptibility to response shift and recall bias...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522718/integration-of-satisfaction-and-quality-of-recovery
#4
REVIEW
Nicolas Bruder, Pascal Auquier
Among patient-reported outcomes, patient satisfaction and quality of recovery are key measures of patient-centred care. The measurement of patient satisfaction should use validated, multidimensional scales. There are general scales that aim to evaluate the entire perioperative period and scales focused on specific periods (post-operative) or techniques (loco-regional anaesthesia). Recovery assessment tools (such as the PostopQRS) share some domains with satisfaction scales and also have major differences by construction...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522717/approaches-to-the-measurement-of-post-operative-recovery
#5
REVIEW
Andrea Bowyer, Colin Royse
Modern recovery assessment has progressed from that which addressed purely physiological restitution in the immediate post-operative period to that which is a multi-dimensional construct existing as a continuum and which follows a predictable trajectory. Recovery tools differ in their derivation, validation and scope of assessment. Importantly, few are validated for repeat measures, an aspect crucial when assessing the temporal nature of modern recovery. Recovery can be assessed as a continuous or dichotomous outcome and as occurring within an individual patient or within a group...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522716/defining-quality-of-recovery-what-is-important-to-patients
#6
REVIEW
Jaume Borrell-Vega, Michelle L Humeidan, Sergio D Bergese
Postoperative recovery is a complex process with several interrelated domains. Traditionally, the absence of negative physiological symptoms like nausea and pain, along with avoidance of major postoperative complications, has been the standard set by clinicians and hospitals for a satisfactory postoperative recovery. Nonetheless, evidence from recent studies reports these items to be the least important from the patient point of view. Effective communication, active involvement of the patient in their healthcare decisions, and empathy from healthcare providers are rated by patients as significant factors for their quality of recovery...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522715/the-patient-s-surgical-journey-and-consequences-of-poor-recovery
#7
REVIEW
Colin F Royse
Quality of recovery is a multidimensional construct that affects individual patients in different ways and during different time periods. The evaluation of quality of recovery requires patient-reported outcome measurement tools that are sensitive in detecting change with time and are preferably objective rather than subjective by nature. Current surgical outcomes are still predominantly focused on the avoidance of complications and reduced cost. The new era of 'value-based care' implies that outcomes of importance to the patient should be a vital metric in determining quality of surgical care...
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30522714/preface-to-patient-centered-clinical-anaesthesiology
#8
EDITORIAL
Colin Royse
No abstract text is available yet for this article.
September 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322466/adjunct-medications-for-peripheral-and-neuraxial-anesthesia
#9
REVIEW
Patrick Ifesinachi Emelife, Matthew R Eng, Bethany L Menard, Andrew S Myers, Elyse M Cornett, Richard D Urman, Alan D Kaye
Regional and neuraxial anesthesia can provide a safer perioperative experience, greater satisfaction, reduced opioid consumption, and reduction of pain, while minimizing side effects. Ultrasound technology has aided clinicians in depositing local anesthetic medication in precise proximity to targeted peripheral nerves. There are a plethora of adjuvants that have been utilized to prolong local anesthetic actions and enhance effects in peripheral nerve blocks. This manuscript describes the current state of the use of adjuncts, e...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322465/pharmacogenomics-precision-medicine-and-implications-for-anesthesia-care
#10
REVIEW
Alan D Kaye, Thomas Mahakian, Aaron J Kaye, Andrew A Pham, Brendon M Hart, Sonja Gennuso, Elyse M Cornett, Rodney A Gabriel, Richard D Urman
The study of how individual genetic differences, known as polymorphisms, change the pharmacokinetics and pharmacodynamics of drugs is called pharmacogenomics. As the field of pharmacogenetics grows and continues to identify genetic polymorphisms, it is promising that the unmet need in this patient population may soon be addressed with personalized drug therapy based on the patient's genetic composition. Although encouraging, pharmacogenomic testing is underutilized in the United States and is often not covered by insurance companies...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322464/perioperative-pharmacology-new-evidence-agents-and-concepts-impacting-perioperative-practice
#11
EDITORIAL
Richard D Urman
No abstract text is available yet for this article.
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322463/pulmonary-vasodilators-latest-evidence-and-outcomes-in-the-perioperative-setting
#12
REVIEW
Charles J Fox, Elyse M Cornett, Brendon M Hart, Aaron J Kaye, Shilpadevi S Patil, Michelle Carroll Turpin, Angelica Valdez, Richard D Urman, Alan D Kaye
Numerous conditions give rise to pulmonary arterial hypertension (PAH), with most of them being idiopathic. Signs and symptoms are generally difficult to recognize initially because they present as nonspecific and typically are mistaken for age-related physiological processes or alternate medical conditions. Many advances have been made toward PAH-specific therapies that have led to advanced clinical management of the disease. The present investigation describes new pulmonary vasodilator agents that are currently available or under development that could impact perioperative management...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322462/new-antihypertensive-medications-and-clinical-implications
#13
REVIEW
D Wong, P N W Tsai, K Y Ip, M G Irwin
Hypertension remains a global public health issue and is a leading preventable risk factor for many causes of mortality and morbidity. Although it is generally managed as an outpatient chronic disease, anaesthetists will inevitably encounter patients with hypertension, ranging from undiagnosed asymptomatic to chronic forms with end-organ damage(s). An understanding of perioperative management of anti-hypertensive pharmacotherapy is crucial. Although many drugs are familiar, new drug groups that have relevance for blood pressure control and perioperative care have evolved in recent years...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322461/newer-propofol-ketamine-and-etomidate-derivatives-and-delivery-systems-relevant-to-anesthesia-practice
#14
REVIEW
N Hulsman, M W Hollmann, B Preckel
Drug discovery is the cornerstone of developments in the field of anesthesia. Each year, new drugs enter the market and possibly change clinical practice. The development of new anesthetics can be divided into two groups. One strategy is the discovery of a new type of drug with unique molecular structure, better clinical properties, and lesser side effects than the already existing drugs. Another strategy is changing the molecular structure of current clinically available anesthetics to create new drugs with better pharmacokinetic and pharmacodynamic properties...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322460/neuromuscular-blockers-and-reversal-agents-and-their-impact-on-anesthesia-practice
#15
REVIEW
Zdravka Zafirova, Allison Dalton
Neuromuscular blockers have long been an intricate part of the anesthesia regimen. The scientific progress in pharmacology and physiology has strengthened their clinical relevance, has helped to delineate with precision their medical role, and has enhanced the safety and effectiveness of their use. New frontiers in research will define further the role of these agents in modern anesthesia practice and guide their expanding and discrete clinical applications.
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322459/perioperative-implications-of-common-and-newer-psychotropic-medications-used-in-clinical-practice
#16
REVIEW
Alan D Kaye, Ryan J Kline, Elliott R Thompson, Aaron J Kaye, Justin A Terracciano, Harish B Siddaiah, Richard D Urman, Elyse M Cornett
Psychotropic medications are widely prescribed by clinicians as both primary therapy for a variety of psychiatric and neurodegenerative diseases and as adjunctive analgesics for use in the perioperative period. It is critical to understand various modes of action, drug-drug interactions, side effects, and clinical implications. Health care providers must understand how these medications interact with anesthetics, as well as other drugs used in perioperative care. We review relevant psychiatric and neurodegenerative diseases, psychotropic medications used to treat them, and how these medications interact with anesthetics and drugs used in perioperative care...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322458/new-local-anesthetics
#17
REVIEW
Jarna Shah, Effrossyni Gina Votta-Velis, Alain Borgeat
Local anesthetics are used for performing various regional anesthesia techniques to provide intraoperative anesthesia and analgesia, as well as for the treatment of acute and chronic pain. Older medications such as lidocaine and bupivacaine as well as newer ones such as mepivacaine and ropivacaine are being used successfully for decades. Routes of administration include neuraxial, perineural, intravenous, various infiltrative approaches, topical, and transdermal. There are new innovations with the use of older local anesthetics in a novel manner, in addition to the development and use of new formulations...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322457/new-anticoagulants-reversal-agents-and-clinical-considerations-for-perioperative-practice
#18
REVIEW
Brendon M Hart, Stephane M Ferrell, Mark W Motejunas, Lauren A Bonneval, Elyse M Cornett, Richard D Urman, Alan D Kaye
There are several new anticoagulants on the market that will impact perioperative care, including the use of these anticoagulant drugs in the setting of regional anesthesia. The ideal pharmacological agent would prevent pathological thrombosis and allow for a normal response to vascular injury to limit bleeding. At present, all antithrombotic agents have increased bleeding risk as their main side effect. We describe the different categories of drugs, e.g., antiplatelet, anticoagulant, and thrombolytic, with particular emphasis on the new drugs that have been introduced into the market...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322456/new-benzodiazepines-for-sedation
#19
REVIEW
Elyse M Cornett, Matthew B Novitch, Andrew J Brunk, Kelly S Davidson, Bethany L Menard, Richard D Urman, Alan D Kaye
There are currently new drugs being developed that have benzodiazepine properties. This review will examine remimazolam, 3-hydroxyphenazapam, adinazolam, clonazolam, and deschloroetizolam as well as other novel agents. All benzodiazepines are protein bound and only moderately lipid soluble. In addition to their baseline properties, they can be enzymatically broken down into active metabolites. The mechanism of action of these medications is related to polysynaptic pathway inhibition via direct interaction with GABA and modifiable chloride channels...
June 2018: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/30322455/what-is-new-in-the-battle-against-postoperative-nausea-and-vomiting
#20
REVIEW
Vahé S Tateosian, Katelynn Champagne, Tong J Gan
The issue of postoperative nausea and vomiting (PONV) still poses a significant burden on our patients. Although rarely associated with a life-threatening condition, it is consistently considered as one of the most undesirable side effects of surgery and anesthesia. There are well-established risk factors for the development of PONV that include patient-related factors, anesthetic technique, use of volatile anesthetics, use of nitrous oxide, duration of anesthesia, opioid administration, and type of surgery...
June 2018: Best Practice & Research. Clinical Anaesthesiology
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