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Best Practice & Research. Clinical Anaesthesiology

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https://www.readbyqxmd.com/read/30049339/how-anesthetists-manage-growing-demands-with-dwindling-resources-in-german-university-hospitals-overview-and-outlook
#1
REVIEW
Juergen Hinkelmann, Joachim Hasebrook, Christiane Goeters, Klaus Hahnenkamp
As a central service provider in medical care, anesthetists manage the growing demand on medical services, thereby increasing specialization and patient morbidity. Various indicators and measurements have been used to match staff capacity, competence, and workload. It remains unclear whether the problems are due to real shortages or "just" to a wrong distribution. Medical services, service development, infrastructure, capacity, and competences of medical staff of 15 departments of anesthesiology at German university hospitals were compared...
March 2018: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/30049338/moving-towards-a-competence-centre-for-geriatric-medicine-and-care-quality-management-and-human-resource-management-as-major-support-factors
#2
REVIEW
Kerstin Löffler, Judith Goldgruber, Gerd Hartinger
Changed employment models, an ageing workforce and demands of new generations are challenging healthcare facilities to go down new paths. Never before have well-qualified staff been as highly sought after within the medical and nursing care sector as they are today. For many years, the Geriatric Health Care Centres of the city of Graz (GGZ)-a large regional health care provider with more than 650 staff across five locations-has focused a lot on the topic of competence management, facilitation of specialist and management careers in nursing and medicine as well as the optimal mix of skills and grades in staffing...
March 2018: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/30049337/integrating-cross-border-emergency-medicine-systems-securing-future-preclinical-medical-workforce-for-remote-medical-services
#3
REVIEW
Tomasz Ucinski, Grzegorz Dolata, Robert Hełminiak, Lutz Fischer, Steffen Fleßa, Bernhard Brehmer, Armin Viert, Volker Grundmann, Sebastian Rehberg, Kathrin Krügel, Maud Partecke, Peter Brinkrolf, Klaus Hahnenkamp, Konrad Meissner
The European Union intends to enable its citizens to interact across borders in relevant areas of society and culture to further integrate neighboring regions. Medicine has not been at the core of recent EU-funded efforts in central Europe, partially due to significant differences in health care administration, delivery, reimbursement, and culture. However, impeding changes in social structure and centralization of specialized care warrant changes in preclinical administration of medical care, which are already transforming practices across developed countries in central Europe...
March 2018: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/30049336/securing-the-future-anaesthetic-workforce
#4
REVIEW
Chris Carey
A suitably skilled workforce that is of an appropriate size is essential for the provision of healthcare services. Anaesthetists play an essential role in a wide range of clinical areas, and effective workforce planning and training are essential in maintaining service provision. Workforce planning requires consideration of a number of different factors related to the workforce itself and services that are required. Long-term predictions must be made, as the process of training a consultant workforce with the flexibility to adapt to changing services takes many years...
March 2018: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/30049335/improving-female-physician-s-careers-in-academic-medicine-chances-and-challenges
#5
REVIEW
Bettina Pfleiderer, Marina Bortul, Silvia Palmisano, Sibyll Rodde, Joachim Hasebrook
University hospitals are involved in the care of critically ill patients, pregraduate and postgraduate education, and medical research with an increasing demand on physicians due to a higher burden of disease. The number of female physicians is increasing; however, young female physicians are less willing to work at university hospitals under the given conditions. They often do not find appropriate working conditions in mostly hierarchically structured university hospitals. Institutional structures involuntarily erect barriers against the recruitment, retention, and career progression of women...
March 2018: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/30049334/securing-the-continuity-of-medical-competence-in-times-of-demographic-change
#6
EDITORIAL
Klaus Hahnenkamp, Joachim Hasebrook, Wolfgang Buhre, Hugo Van Aken
No abstract text is available yet for this article.
March 2018: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739543/special-indications-for-opioid-free-anaesthesia-and-analgesia-patient-and-procedure-related-including-obesity-sleep-apnoea-chronic-obstructive-pulmonary-disease-complex-regional-pain-syndromes-opioid-addiction-and-cancer-surgery
#7
REVIEW
Adrian Sultana, David Torres, Roman Schumann
Opioid-free anaesthesia (OFA) is a technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with the anaesthetic. Opioid-free analgesia similarly avoids opioids in the perioperative period. There are many compelling reasons to avoid opioids in the surgical population. A number of case reports and, increasingly, prospective studies from all over the world support its benefits, especially in the morbidly obese population with or without sleep apnoea. A derivative technique is opioid sparing, where the same techniques are used but some opioid use is allowed...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739542/different-protocols-used-today-to-achieve-total-opioid-free-general-anesthesia-without-locoregional-blocks
#8
REVIEW
Eckhard Mauermann, Wilhelm Ruppen, Oliver Bandschapp
With increasing awareness of both short- and long-term problems associated with liberal perioperative opioid administration, the need for routinely and clinically feasible alternatives is greater than ever. Opioid-free anesthesia-previously reserved for bariatric surgery-is receiving increasing attention in mainstream anesthesia. In this review, we present the truly multimodal concept of opioid-free anesthesia, which circumvents a number of opioid-related problems. For a concrete clinical perspective, we present in depth our opioid-free protocol for bariatric surgery...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739541/stable-anesthesia-with-alternative-to-opioids-are-ketamine-and-magnesium-helpful-in-stabilizing-hemodynamics-during-surgery-a-systematic-review-and-meta-analyses-of-randomized-controlled-trials
#9
REVIEW
Patrice Forget, Juan Cata
INTRODUCTION: The role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery. METHODS: The available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739540/intravenous-lidocaine
#10
REVIEW
Jean-Pierre Estebe
Lidocaine has analgesic effect and antihyperalgesic and anti-inflammatory properties, which enable its use as a general anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, postoperative pain, and/or analgesic requirements. However, its mechanisms of action remain unclear, despite its different known properties. Although the exact mechanism of action remains uncertain, initial bolus followed by a continuous lidocaine infusion has clear analgesic benefits...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739539/additives-used-to-reduce-perioperative-opioid-consumption-1-alpha2-agonists
#11
REVIEW
Peter H Tonner
Because of their significant side effects, especially in obese patients, the routine perioperative use of opioids has been questioned recently. Alpha2 -agonists are drugs with a considerable analgesic potency with the potential to reduce opioid consumption. Alpha2 -agonists bind to alpha2 -adrenergic receptors in the CNS and peripherally. They inhibit the central sympathetic outflow, resulting in an attenuation of blood pressure and heart rate and in a sparing effect on anaesthetics and analgesics. In the postoperative period alpha2 -agonists provide an analgesic effect without respiratory depression and other known opioid side effects...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739538/opioid-related-side-effects-postoperative-ileus-urinary-retention-nausea-and-vomiting-and-shivering-a-review-of-the-literature
#12
REVIEW
Hans Donald de Boer, Olivier Detriche, Patrice Forget
Opioids are widely used in clinical anesthesia. However, side effects include postoperative nausea and vomiting, shivering, ileus, and urine retention and are specifically discussed here. From the available evidence, it appears that the use of opioids is strongly associated with impaired gastrointestinal motility. Therefore, to prevent postoperative ileus, the use of opioids should be minimized and opioids should be replaced by other drugs. With regard to the risk of postoperative urinary retention, one problem is the lack of standardized definition...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739537/opioid-free-anesthesia-opioid-side-effects-tolerance-and-hyperalgesia
#13
REVIEW
Patricia Lavand'homme, Arnaud Steyaert
Opioids are the most potent drugs used to control severe pain. However, neuroadaptation prevents opioids' ability to provide long-term analgesia and produces opposite effects, i.e., enhancement of existent pain and facilitation of chronic pain development. Neuroadaptation to opioids use results in the development of two interrelated phenomena: tolerance and "opioid-induced hyperalgesia" (OIH). Tolerance, a pharmacologic concept, and OIH, a clinical syndrome, have been mostly observed under experimental conditions in animals and in human volunteers...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739536/opioids-respiratory-depression-and-sleep-disordered-breathing
#14
REVIEW
Mahesh Nagappa, Toby N Weingarten, Gaspard Montandon, Juraj Sprung, Frances Chung
The increasing use of opioids in the perioperative period has increased opioid-associated morbidity and mortality. There is a well-established connection between opioids, sleep-disordered breathing (SDB), and respiratory depression. The treatment of postoperative pain with opioids in patients with SDB may result in respiratory depression. In an unmonitored setting, it may lead to life-threatening respiratory events. More studies are required to evaluate the effective management and prevention of respiratory depression in patients with SDB...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739535/do-we-feel-pain-during-anesthesia-a-critical-review-on-surgery-evoked-circulatory-changes-and-pain-perception
#15
REVIEW
A Cividjian, F Petitjeans, N Liu, M Ghignone, M de Kock, L Quintin
The difficulty of defining the three so-called components of « an-esthesia » is emphasized: hypnosis, absence of movement, and adequacy of anti-nociception (intraoperative « analgesia »). Data obtained from anesthetized animals or humans delineate the activation of cardiac and vasomotor sympathetic reflex (somato-sympathetic reflex) and the cardiac parasympathetic deactivation observed following somatic stimuli. Sympathetic activation and parasympathetic deactivation are used as monitors to address the adequacy of intraoperative anti-nociception...
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29739534/opioid-free-general-anesthesia-a-new-paradigm
#16
EDITORIAL
J Mulier, M Dekock
No abstract text is available yet for this article.
December 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248148/acute-kidney-injury-in-pediatric-patients
#17
REVIEW
David M Kwiatkowski, Scott M Sutherland
Acute kidney injury (AKI) is highly prevalent among hospitalized children, especially those who are critically ill. The incorporation of pediatric elements into consensus definitions has led to a greater understanding of pediatric AKI epidemiology, risk factors, and outcomes. The best available data suggest that AKI occurs in 5% and 27% of non-critically ill and critically ill children, respectively. Additionally, AKI and fluid overload are independently associated with worse outcomes including mortality. Currently, the diagnosis of AKI relies upon urine output and creatinine measurements, both of which pose unique problems in children...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248147/sequelae-of-aki
#18
REVIEW
Samir S Patel, Carlos E Palant, Vrinda Mahajan, Lakhmir S Chawla
Large epidemiologic studies in a variety of patient populations reveal increased morbidity and mortality that occur months to years after an episode of acute kidney injury (AKI). Even milder forms of AKI have increased associated morbidity and mortality. Residual confounding may account for these findings, but considering the huge number of individuals afflicted with AKI, the sequelae of AKI may be a very large public health burden. AKI may simply be a marker for increased risk, but there is increasing evidence that it is part of the causal pathway to chronic kidney disease...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248146/renal-recovery
#19
REVIEW
Ivan Göcze, Christina Wiesner, Hans J Schlitt, Tobias Bergler
Recovery patterns after acute kidney injury (AKI) have increasingly become the focus of research, because currently available preventive measures and specific therapeutic intervention are limited. Moreover, changes in renal functional reserve are recognized as a "hidden" indicator of kidney susceptibility to either acute kidney injury or chronic kidney disease. Understanding these phenomena and their association with outcome may enable the initiation of strategies that facilitate fast and sustained recovery during the time course of AKI and limit AKI progression towards chronic kidney disease...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#20
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
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