Anesthesia information management systems.

PURPOSE OF REVIEW: This review will summarize and comment upon recent developments in the evolution and implementation of anesthesia information management systems (AIMS) in current practice. RECENT FINDINGS: Availability of inexpensive hardware components has greatly reduced costs, and AIMS are now widely available as 'off-the-shelf' software systems, yet AIMS are currently in use in only a minority of institutions and anesthetic practices. AIMS have evolved rapidly from simple automated record-keeping systems to key components of modern medical information networks. The databases generated by AIMS are becoming the basis for establishing 'best practices' and for comparing patient care outcomes. SUMMARY: The searchable, timed, and dated perioperative documentation generated by an AIMS appears to be an evolving requirement for contemporary anesthetic practice. The obstacles to more widespread AIMS adoption appear to be behavioral and financial rather than technical.

Anesthesia information management system implementation: a practical guide.

Anesthesia Information Management Systems (AIMS) display and archive perioperative physiological data and patient information. Although currently in limited use, the potential benefits of an AIMS with regard to enhancement of patient safety, clinical effectiveness and quality improvement, charge capture and professional fee billing, regulatory compliance, and anesthesia outcomes research are great. The processes and precautions appropriate for AIMS selection, installation, and implementation are complex, however, and have been learned at each site by trial and error. This collaborative effort summarizes essential considerations for successful AIMS implementation, including product evaluation, assessment of information technology needs, resource availability, leadership roles, and training.

Clinical implications of mitochondrial disease.

The terms mitochondrial myopathy, mitochondrial cytopathy and inherited mitochondrial encephalomyopathy encompass a large grouping of syndromes produced either by genetically transmitted or acquired disruption of mitochondrial energy production or biosensor function. Many of these disorders are clinically apparent during infancy, but for some the metabolic signs of oxidative stress may not appear until the young or middle adult years. Initially thought to be a rare disorder, it now appears that mitochondrial dysfunction is relatively common but often unrecognized because symptoms are extremely variable and usually insidious in onset. It has also become apparent that mitochondrial dysfunction is a component of many common cardiovascular and neurological disease states and of physiologic aging. Recent advances in our understanding of the mechanisms of mitochondrial dysfunction may explain and link a wide variety of clinical phenomena. This review summarizes the current knowledge regarding the clinical implications of inherited and acquired mitochondrial disease, the effects of anesthetics on mitochondrial function, and the extent to which mitochondrial bioenergetic state determines anesthetic requirement and potential anesthetic toxicity.

Clinical implications of mitochondrial dysfunction.

Mitochondria produce metabolic energy, serve as biosensors for oxidative stress, and eventually become effector organelles for cell death through apoptosis. The extent to which these manifold mitochondrial functions are altered by previously unrecognized actions of anesthetic agents seems to explain and link a wide variety of perioperative phenomena that are currently of interest to anesthesiologists from both a clinical and a scientific perspective. In addition, many surgical patients may be at increased perioperative risk because of inherited or acquired mitochondrial dysfunction leading to increased oxidative stress. This review summarizes the essential aspects of the bioenergetic process, presents current knowledge regarding the effects of anesthetics on mitochondrial function and the extent to which mitochondrial state determines anesthetic requirement and potential anesthetic toxicity, and considers some of the many implications that our knowledge of mitochondrial dysfunction poses for anesthetic management and perioperative medicine.

The elderly outpatient: current anesthetic implications.

PURPOSE OF REVIEW: The present overview describes recent contributions to the literature with regard to choice of anesthetic techniques, approaches to anesthetic management of elderly outpatients undergoing arthroscopy and other procedures, reconsideration of the problem of postoperative delirium in the elderly patient, and a general summary of perioperative management and assessment of anesthetic risk in older adults. RECENT FINDINGS: Major advances in monitoring technology, pharmacology, and comprehensive preoperative assessment have reduced the probability of major adverse outcomes for geriatric surgical patients to low levels. Therefore, it has become difficult to demonstrate clear-cut superiority for any specific anesthetic agent or approach. Nevertheless, the need for prompt and complete recovery of consciousness and rapid discharge after surgery presents additional challenges for the anesthesiologist who is caring for elderly outpatients with regard to prompt recovery of cognitive function and suppression of nausea and vomiting. SUMMARY: The efficiency and speed with which outpatient surgery and anesthetic recovery can be conducted in older adults continue to improve. Monitors of depth of anesthesia, ultra-short-acting agents, and combined techniques have minimized minor complications such as nausea and vomiting, and have improved the speed with which these patients recover from anesthesia. A small proportion of elderly surgical outpatients remain at risk for residual postoperative cognitive dysfunction.