Kayalvarado9445

PURPOSE OF REVIEW Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia. RECENT FINDINGS Simulation training is becoming more integrated in the modern education of anesthesiologists. Research regarding the most effective way to perform simulation training in terms of learning outcomes and long-term skill retention has started to appear. Scenarios which are played independently and that allow for simulated mortality, as well as relaxation techniques before debriefing might have positive effects in this regard. Furthermore, simulation has been investigated as a tool to improve patient safety in low-resource settings. In addition, simulation training in the domain of obstetrics has been rapidly expanding and has an important role in this field of medicine as well. SUMMARY Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.PURPOSE OF REVIEW As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs). RECENT FINDINGS DOACs have favorable pharmacokinetics including quick onset of action and short half-lives. Periprocedural management of DOACs relies heavily on drug half-life as well as procedural risk of bleeding. Other than a few exceptions, the American College of Cardiologists generally recommends complete clearance of oral anticoagulants prior to high-risk bleeding procedures and partial clearance prior to low-risk bleeding procedures. Procedures with little to no clinical risk of bleeding can be performed without any drug interruption or during trough levels. Exceptions to periprocedural DOAC management pertain to electrophysiology procedures. SUMMARY With the exception of no clinically relevant bleeding risk or certain electrophysiology procedures, DOACs should be discontinued periprocedurally in accordance with bleeding risks and drug's half-life. Bridging is generally not recommended for DOACs.PURPOSE OF REVIEW Both cannabis and e-cigarette use are increasing, particularly among adolescents. The use of cannabis products may impact patients' physiology under anesthesia. Understanding the effects of cannabis and vaping are critical to the provision of safe and effective anesthetic care. RECENT FINDINGS E-cigarettes have recently been implicated in a severe presentation of acute lung injury, often in association with vaporization of the cannabinoid, THC. E-cigarette use appears to be associated with other less-acute pulmonary adverse effects that are yet to be fully understood. Cannabis affects many organ systems with alterations in cardiovascular, respiratory and neurological function. Specifically, there is emerging evidence that cannabis use may reduce the efficacy of sedative agents and postoperative pain management efforts. SUMMARY There is a very wide variety of cannabis products currently available, with respect to both route of administration as well as cannabinoid content. Patients using cannabis products prior to anesthesia may present with altered physiology that place them at increased risk for cardiovascular and respiratory complications. They may also be tolerant to the effects of propofol and opioid for pain management, thus consideration should be given to use of a multimodal regimen.PURPOSE OF REVIEW Jehovah's Witnesses have religious beliefs that preclude transfusion of blood products and certain medical interventions. This presents a unique dilemma and ethical challenge to healthcare providers, especially in a surgical setting. RECENT FINDINGS The growing number of followers of this faith warrants a deeper look at the ethical, legal, and clinical implications of their beliefs. Advances in patient blood management now allow timely optimization before surgery. SUMMARY Anticipating the challenges associated with managing and optimizing patients who refuse blood products allows for more favorable outcomes in the preoperative period.PURPOSE OF REVIEW Over the last 3 years and for the first time in 60 years, life expectancy in the United States has declined across all racial groups primarily because of drug overdoses, alcohol abuse, and suicide. A public health response to the opioid crisis must expand its focus to more broadly include children, adolescents, and young adults while increasing efforts toward preventing new cases of opioid addiction, early identification of individuals with opioid-abuse disorder, and ensuring access to effective opioid addiction treatment, while simultaneously continuing to safely meet the needs of patients experiencing pain. RECENT FINDINGS Although a multimodal approach to pain management is fundamental in current practice, opioids remain an essential building block in the management of acute and chronic pain and have been for over 5000 years as they work. this website Left over, unconsumed opioids that were appropriately prescribed for pain have become the gateway for the development of opioid use disorder, particularly in the vulnerable adolescents and young adult patient populations. How to reduce the amount of opioids dispensed, improve methods of disposal in an environmentally safe way, and proactively make naloxone, particularly nasal spray, readily available to patients (and their families) receiving prescription opioids or who are at risk of opioid use disorder are highlighted in this review. SUMMARY We describe the historical use of opioids and the scope of the current opioid crisis, review the differences between dependence and addiction, and the private and public sectors response to pain management and highlight the issue of adolescent vulnerability. We conclude with a proposal for future directions that address both public and patient health needs.