Current Opinion in Anesthesiology

Critical patient safeguards for ambulatory surgery centers
Eklund JE, Chang CC and Donnelly MJ
The role of ambulatory surgery centers in surgical care is evolving, as lower facility fees and improved patient experience increase the popularity of these venues. As care expands in ambulatory surgery center, so does the complexity of cases and patients cared for in these centers, which may pose a risk for patient safety. Anesthesiologists should lead multidisciplinary teams to screen for appropriate patients and procedures.
More than pacemakers and defibrillators: perioperative management of implantable devices for patient safety
Harbell MW, Kraus MB, Lopez-Ruiz A, Gerasimov M and Maloney JA
The use of implantable medical devices (IMDs) continues to increase with estimates that 10% of the American population will have an IMD in their lifetime. IMDs require special considerations for management in the perioperative period to ensure optimal patient care and patient safety. This review summarizes the current perioperative considerations for IMDs.
The electronic health record: does it enhance or distract from patient safety?
Tewfik G, Rivoli S and Methangkool E
The electronic health record (EHR) is an invaluable tool that may be used to improve patient safety. With a variety of different features, such as clinical decision support and computerized physician order entry, it has enabled improvement of patient care throughout medicine. EHR allows for built-in reminders for such items as antibiotic dosing and venous thromboembolism prophylaxis.
Safety amid the scalpels: creating psychological safety in the operating room
Cohen JB, Feldman-Brillembourg JA, Cheng J and Rangrass G
We briefly review the concept of psychological safety and discuss the actions that can create it in the anesthesiologist's work environment.
Educating for success: ambulatory anesthesia training
Cormier NR, Hyman JB and O'Rourke M
This article explores the unique intersection of the challenges confronting ambulatory anesthesiology education and charts a trajectory forward. The proportion of ambulatory, nonoperating room (NORA), and office-based surgical cases continues to rise; however, the requirements for trainees in these settings have remained static. The rapid evolution of the field combined with a limited workforce also makes continuing education essential, and we discuss the current and future states of ambulatory anesthesia education.
Depth of anesthesia monitoring: an argument for its use for patient safety
Brook K, Agarwala AV, Li F and Purdon PL
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.
Preventing perioperative infections: a call to action for anesthesiologists
Gerasimov M, Lin DM, Munnur U and Donnelly M
Surgical site infections (SSI) are one of the most costly complications and hospital organizations are promoting multidisciplinary approaches to address this harm. Anesthesiologists are increasingly recognized as key players influencing surgical outcomes and patient safety, and play a key role in preventing SSIs.
Medication errors and mitigation strategies in obstetric anesthesia
Sharpe EE, Corbett LM and Rollins MD
Medication administration errors represent a significant yet preventable cause of patient harm in the peripartum period. Implementation of best practices contained in this manuscript can significantly reduce medication errors and associated patient harm.
The role of human factors engineering in patient safety
Fermin L, Lobaugh L, Parr KG and Currie M
To explore the collaboration between human factors (HFs) experts and clinicians in order to improve perioperative patient safety.
Dental sedation permit requirements for physician anesthesiologists in the United States and the European Union: a review
Yun S, Martin-Orr N and Hendrix M
This review addresses the dental sedation permit requirements for physician anesthesiologists in the United States and the European Union (EU). The regulatory landscape for office-based anesthesia, including dental settings, is often described as the 'Wild West' of patient safety, making it crucial to outline the similarities and differences in dental anesthesia regulations and offer practical guidelines for regulators.
Ambulatory anesthesia: beyond the operating room
Rajan N
Best perioperative practices in the management of obstructive sleep apnea patients undergoing ambulatory surgery
Pappu A and Singh M
This review is timely due to the increasing prevalence of obstructive sleep apnea (OSA) among patients undergoing ambulatory surgery, necessitating updated perioperative management strategies to improve outcomes and reduce complications.
Caring for patients with diabetes in the outpatient surgical setting: current recommendations and controversies
Duggan EW and Umpierrez GE
Perioperative outpatient (ambulatory) care of the adult patient with diabetes requires unique considerations that vary from the inpatient setting. This review highlights specific pre, intra, and postoperative care steps for patients with diabetes undergoing ambulatory surgery, summarizing recent clinical trials, expert reviews, and emerging evidence.
Harnessing innovation to improve patient safety in anesthesiology
Harbell MW
Beyond adverse events in anesthesiology: 'unanticipated events' and strategies for improved reporting
Brook K, Wilde M, Vannucci A and Agarwala AV
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.
Cardiovascular procedures in ambulatory cardiac procedures: really?
Davila VR, Saklayen S and Tang J
To evaluate the current trends, safety, and feasibility of same-day discharge (SDD) in ambulatory cardiac procedures, with a focus on percutaneous coronary interventions (PCI). This review also discusses the impact of technological advancements and explores future directions for expanding the scope of SDD in more complex cardiac procedures.
The climate crisis - actions to prioritize for anaesthesiologists
Lawin-O'Brien R, Schwartz ES, Montgomery H, Nurok M and Coburn M
Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do.
Perioperative risk scores: prediction, pitfalls, and progress
Bedford JP, Redfern OC, O'Brien B and Watkinson PJ
Perioperative risk scores aim to risk-stratify patients to guide their evaluation and management. Several scores are established in clinical practice, but often do not generalize well to new data and require ongoing updates to improve their reliability. Recent advances in machine learning have the potential to handle multidimensional data and associated interactions, however their clinical utility has yet to be consistently demonstrated. In this review, we introduce key model performance metrics, highlight pitfalls in model development, and examine current perioperative risk scores, their limitations, and future directions in risk modelling.
Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia
Campbell A, Jacoby M and Hernandez N
The purpose of this article is to provide an update of regional anesthesia and its applications in the critical care patient population.
Perioperative pain management for cardiac surgery
Yakubi M, Curtis S and Anwar S
Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery.
Chronic consequences of accidental dural puncture and postdural puncture headache in obstetric anaesthesia - sieving through the evidence
Armstrong S and Fernando R
Accidental dural puncture (ADP) and postdural puncture headache (PDPH) are relatively common complications of neuraxial anaesthesia and analgesia in obstetrics. Both may result in acute and chronic morbidity. This review intends to discuss the chronic implications of ADP and PDPH and raise awareness of severe and potentially life-threatening conditions associated with them.