Communication in the Operating Room Setting.

Ideal and effective communication consists of a clear, audible, and focused message from a transmitter that is delivered to an attentive, undistracted receiver, and consists of both verbal and nonverbal types. Communication in the health care setting is highly complex and dynamic, involving multiple settings, participants, and unique challenges. Effective communication in the perioperative environment is a requirement for safe patient care delivery and an important element of teamwork. A message must be accurately delivered in a uniquely high-risk and time-sensitive location, beset with numerous distractions, barriers, and challenges. Surgical checklists and time-out procedures have promoted a standardized, "all-hands" approach to addressing some of the challenges to effective communication in the perioperative environment. Postoperative debriefing sessions have demonstrated effectiveness in improving team functioning in the simulated learning environment and hold promise as another strategy to address these challenges, but require further research and development. Other promising strategies to improve effective perioperative communication are focused on team building activities and minimizing distractions at critical time points within patient care delivery, but to date are not substantiated by evidence. Future research is necessary to examine these novel approaches to improving communication in the perioperative environment to influence the safety of patient care delivery in this highly challenging health care setting. Wise men speak because they have something to say; Fools because they have to say something. Plato.

Wet or Dry? A Review of Intravenous Fluid Administration in Anesthesia Practice.

Fluid therapy has dramatically changed since its early inception nearly 200 years ago. Administration of intravenous fluid (IVF) has evolved from a "drip" technique to the algorithmic approach of the anesthetic fluid plan, and is now moving toward Goal-Directed Fluid Therapy. As the science and culture of fluid management evolves, anesthetists must remain focused on "why" anesthetic fluid matters. The purpose of IVF administration is to support tissue perfusion and maintain euvolemia. As the evidence underlying perioperative practice matures and the science of anesthesia races to meet the evolving demands of surgery, anesthetists must align knowledge generation with the individualized needs of the patient. The future of perioperative IVF therapy will be patient centric. In the near future, anesthetists will know the patient's blood volume before, during, and after the surgery. They will no longer depend on inaccurate surrogates to estimate, but have the knowledge to titrate fluids to maintain a zero balance. Practice will move away from algorithms and toward individualized fluid administration based on reproducible end points. Decisions about fluid selection, timing, and volume will be driven by patient- and case-specific requirements as specific as when a patient is typed and crossed for blood transfusion. The greatest challenge for the anesthetist in perioperative fluid therapy is to move beyond the dogmatic practices of the past and toward fluid therapy guided by patient centric evidence.