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Chapter 14. Developing Regional Anesthesia Pathways

An anesthetic pathway depends on:

A. The institution

B. The techniques used by surgeons

C. The techniques used by anesthesiologists

D. All of the above

D is correct. Benefits of an anesthetic pathway will of course depend on the peculiarities of the pathway itself, the institution, the surgical and anesthetic techniques, and the other health-care providers using the pathway (such as nursing care and physical therapy). A pathway designed for one institution may not be appropriate for another institution. Furthermore, the goals of an anesthetic pathway may vary; some pathways may be designed to reduce morbidity and mortality, whereas others may be focused on reducing cost while maintaining a high level of patient care.

Which of the following is not a goal of an anesthetic pathway?

A. Brief and clear guidelines for every health-care provider involved in the pathway

B. Clinician can focus on characteristics of a patient instead of characteristics of a cohort

C. Reduce perioperative complications and risks

D. Same consistent treatment for every patient

D is correct. Same consistent treatment for every patient is not a goal of an anesthetic pathway. Pathways should not be indiscriminately adhered to, as some patients will require modification to atone for specific medical conditions or patient preferences.

Although developing a clinical pathway often involves lengthy analyses with uncertainties, final pathway elements should be brief and specific. Benefits of an anesthetic pathway will depend on all health-care providers using the pathway.

Characteristics of an entire cohort were already examined during pathway development, so clinicians can focus on modifications of the pathway to atone for specific patient characteristics.

A recent meta-analysis of clinical pathways found that they were associated with lower rates of patient complications.1

Which of the following is an advantage for choosing local and regional anesthesia (LRA) over general anesthesia (GA)?

A. LRA can give additive pain control in the postoperative period.

B. LRA can give additive pain control postoperatively and can affect morbidity and mortality.

C. The operation is in a daycare setting.

D. LRA reduces costs and complications.

B is correct. Regional anesthesia (either neuraxial or peripheral block) is often a key feature of anesthetic pathway ...

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