The inexorable rise in health care costs has brought ever greater emphasis on cost reduction in all aspects, including anesthesia care. Intraoperative anesthesia-related expenditures comprise upward of 6% of the total hospital cost for an inpatient procedure. This article describes efforts at Ohio State to reduce both direct and environmental procedural costs while maintaining environmental stewardship.

There is no doubt we have moved forward considerably in the past decade with our understanding of the cognitive disorders associated with anesthesia and surgery in older individuals, but there is still a long way to go. In order to begin to understand where perioperative neurocognitive disorders (PND) exist in the overall cognitive and functional trajectory of an individual, we must move forward and implement the same criteria for PND that is used for cognitive impairment in the community.

Anesthesiologists do their best to avoid the problem, but they still occasionally fail, handing over emesis basins as unfortunate patients heave into them. Perioperative nausea and vomiting is both feared and loathed, and is a significant detractor to patient experience and anesthesia-related quality metrics. This month’s Expert is Dr. T.J. Gan, a physician-scientist well versed in the epidemiology and treatment of all things nausea and vomiting-related. He will provide a refresher and some clinical guidance on the quest to reduce “n/v” rates to as close to zero as possible.

The reasons for career hiatus vary tremendously, ranging from family obligations to recovering from a personal illness. Because clinical competency requires constant maintenance of technical and critical decision-making skills, particularly during rapidly changing clinical situations, anesthesiologists are hesitant to take a hiatus when it is unclear how to reenter clinical work. However, it is important to note that there are options available to allow for reentry, providing a safety net for the individual anesthesiologist. This support is not only beneficial to the individual but also to the specialty.