Speckle Tracking Strain Echocardiography: On Its Way into the Operating Room
AbstractPurpose of ReviewThe purpose of this review is to introduce the basic concepts of strain as well as its applicability to intraoperative echocardiography.Recent FindingsIn the operating room, strain literature is in its infancy. The majority of the strain literature is based on TTE studies. Currently, there are no published guidelines on the normal values of strain with TEE. Early strain literature has shown there is correlation between TTE and TEE values. Reduction in intraoperative left ventricular strain with TEE has been shown to be an independent predictor of prolonged hospitalization, postoperative atrial fibr...
Source: Current Anesthesiology Reports - July 10, 2019 Category: Anesthesiology Source Type: research

Levosimendan: What Have We Learned So Far?
AbstractPurpose of ReviewVasoactive therapy represents a pivotal yet debated topic in critically ill patients and in those with chronic heart failure. Levosimendan, a calcium sensitizer agent with inodilating properties, has been in the market for 27  years and new indications came out over time. The aim of the present review is to highlight what is actually proven and what is debated on the use of levosimendan in light of its pharmacologic features and the pathophysiological evidence.Recent FindingsLevosimendan was firstly seen as an inodilator acting through calcium sensitization in myocytes both in the myocardium a...
Source: Current Anesthesiology Reports - July 10, 2019 Category: Anesthesiology Source Type: research

Neurological Complications in Cardiac Surgery
AbstractPurpose of ReviewPerioperative neurological complications have a significant impact on mortality, morbidity, and quality of life in a growing number of high-risk patients undergoing cardiac surgery. In this comprehensive review, we provide an outline of the current literature with regard to stroke, perioperative neurocognitive disorders (delirium and cognitive decline), postoperative visual loss, and peripheral nerve injury in cardiac surgery.Recent FindingsCardiac surgeons, anesthesiologists, and critical care specialists are facing a new population of cardiosurgical patients who are older and sicker than in previ...
Source: Current Anesthesiology Reports - July 4, 2019 Category: Anesthesiology Source Type: research

Perioperative Multimodal Pain Management: an Evidence-Based Update
AbstractPurpose of reviewThe purpose of this article is to provide a concise review of recent updates and ongoing controversies in perioperative multimodal analgesia with a specific focus on systemic pharmacologic options.Recent findingsAcetaminophen, non-steroidal anti-inflammatory drugs, and ketamine provide clear benefit for analgesia and opioid sparing, with wide safety margins at clinically relevant doses. Enthusiasm is waning for the use of gabapentinoids (gabapentin and pregabalin) and systemic alpha-2 agonists (clonidine and dexmedetomidine) due to small benefit and a potentially dangerous side effect profile (seda...
Source: Current Anesthesiology Reports - July 3, 2019 Category: Anesthesiology Source Type: research

Pecs and Serratus Blocks: Current State of Chest Wall Analgesia
This article seeks to provide a current review of pertinent literature with regards to analgesia for chest wall surgery —specifically Pecs and serratus blocks.Recent FindingsIntermuscular plane blocks have been shown to be clinically efficacious in the setting of chest wall surgery, especially in the setting of oncologic breast surgery.SummaryPecs and serratus blocks provide a safe and effective alternative to neuraxial analgesia while avoiding many of the associated technical difficulties and potential complications. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - July 3, 2019 Category: Anesthesiology Source Type: research

From the Physiology to the Bedside: Fluid Therapy in Cardiac Surgery and the ICU
AbstractPurpose of ReviewIn this review, we summarize the evidence present in the literature about this important field, with particular attention to the peculiarities of cardiac surgery.Recent FindingsSince water is the main component of human cells and tissue, together with electrolytes and proteins, the manipulation of this element in critical illness is a powerful tool in the hands of the anesthesiologist and intensive care doctor. It can be either extraordinarily effective in the treatment of the patient ’s disease and in correcting the hemodynamic instability or it can lead to very dangerous consequences, such ...
Source: Current Anesthesiology Reports - July 3, 2019 Category: Anesthesiology Source Type: research

Upper Limb Blocks: Advances in Anesthesiology Research
AbstractPurpose of ReviewTo summarize the recent literature regarding regional anesthesia of the upper extremity.Recent FindingsBrachial plexus anatomy is more variable than previously believed. Several novel techniques for upper extremity blockade have been recently described. The ability of local anesthetic adjuvants and liposomal bupivacaine to prolong block duration has been investigated with mixed results. Regional anesthesia has played an important role in the expansion of ambulatory upper extremity surgery, especially shoulder arthroscopy and arthroplasty. Knowledge about the management of local anesthetic systemic ...
Source: Current Anesthesiology Reports - June 25, 2019 Category: Anesthesiology Source Type: research

Patient Blood Management in Cardiac Surgery
AbstractPurpose of the ReviewRecently, several large randomized studies and recommendations regarding patient blood management (PBM) in cardiac surgery were published. This review summarizes the current evidence relating to modern strategies in PBM from the perspective of the cardiovascular anesthesiologist.Recent FindingsPreoperative anemia should be early detected and adequately managed. In patients with intake of anticoagulants or platelet inhibitors, timely and specific stopping should be respected. Specific modification of cardiopulmonary bypass (CPB) systems aiming to reduce hemodilution and conserve patients ’...
Source: Current Anesthesiology Reports - June 25, 2019 Category: Anesthesiology Source Type: research

Quadratus Lumborum Block: a Technical Review
AbstractPurpose of ReviewUltrasound-guided quadratus lumborum block (QLB) is gaining popularity in regional anesthesia for various surgical procedures. The purpose of this review is to understand the relevant clinical anatomy, different mechanisms of actions, and techniques used for the block and clinical evidence so far.Recent FindingsThe current data suggests a wide dermatomal distribution of the local anesthetic from T7-L2. The evidence regarding its utility is still evolving but has shown reduced opioid requirements for cesarean sections, lower abdominal surgery, and hip surgery. Prolonged analgesia has been reported a...
Source: Current Anesthesiology Reports - June 22, 2019 Category: Anesthesiology Source Type: research

The Adductor Canal Block: a Clinical Review
AbstractPurpose of ReviewTo provide an overview of the adductor canal block (ACB), with specific discussion on its scope of practice in regional anesthesia for total knee arthroplasty (TKA).Recent FindingsACB is emerging as a viable alternative to femoral nerve block (FNB) as a purely sensory blockade providing comparable postoperative analgesia after TKA. There is growing evidence that it is non-inferior to FNB in terms of pain control, opioid consumption, and earlier ambulation without the risk of quadriceps muscle weakness.SummaryThe saphenous nerve can be effectively blocked at the adductor canal and, in conjunction wi...
Source: Current Anesthesiology Reports - May 23, 2019 Category: Anesthesiology Source Type: research

Laparoscopic Surgery in Pediatrics
AbstractPurpose of ReviewThe motivation of this review is to deepen our understanding of the physiological changes that occur during laparoscopic surgery in pediatric patients in order to detect possible complications in time to intervene and to provide the most appropriate monitoring.Recent FindingsLaparoscopic surgery has evolved rapidly in recent years and is considered a standard procedure in pediatric surgery. This surgical technique includes the use of pneumoperitoneum which, when combined with extreme positions (e.g., steep Trendelenburg) leads to hemodynamic, respiratory, and neuroendocrine changes, among others, w...
Source: Current Anesthesiology Reports - May 14, 2019 Category: Anesthesiology Source Type: research

Local Anesthetic Additives for Regional Anesthesia: a Review of Current Literature and Clinical Application
This article reviews current literature to provide clinically relevant information about common nerve block additives, describing rationale for their use, effect on block onset, extension of block duration, and safety profiles of the additives. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - May 14, 2019 Category: Anesthesiology Source Type: research

Stage 1 Palliation of Hypoplastic Left Heart Syndrome: What the Pediatric Anesthesiologist Needs to Know
AbstractPurpose of ReviewThe purpose of this review is to discuss the features of stage 1 palliation of hypoplastic left heart syndrome (HLHS). Comparison will be made between traditional surgical approaches and hybrid approaches. Anesthetic considerations for infants with these types of palliations will be discussed.Recent FindingsWhile historically surgical palliation in the neonatal period or neonatal heart transplant has been the primary means of survival for neonates with HLHS, in the last two decades, more centers have been performing hybrid palliation of this defect. This palliation can be performed with the expecta...
Source: Current Anesthesiology Reports - May 9, 2019 Category: Anesthesiology Source Type: research

Erector Spinae Plane (ESP) Block: a New Paradigm in Regional Anesthesia and Analgesia
AbstractPurpose of ReviewThe erector spinae plane (ESP) block is an ultrasound-guided regional anesthesia technique that has enjoyed unprecedented popularity since its description in 2016. This review summarizes the applied anatomy, technical performance, and clinical application of the ESP block.Recent FindingsDissection and imaging studies indicate that paravertebral local anesthetic spread is a primary mechanism of action of the ESP block. A large volume of case report literature supports its efficacy in myriad clinical settings, including thoracic surgery, thoracic trauma, cardiac surgery, abdominal surgery, spine surg...
Source: Current Anesthesiology Reports - May 2, 2019 Category: Anesthesiology Source Type: research

New-Onset Atrial Fibrillation in Adult Patients After Cardiac Surgery
AbstractPurpose of ReviewAn overview of recent literature regarding pathophysiology, risk factors, prophylaxis, and treatment of new-onset atrial fibrillation (AF) in post-cardiac surgical patients.Recent FindingsAF is the most frequent adverse event after cardiac surgery with significant associated morbidity, mortality, and financial cost. Its causes are multifactorial, and models to stratify patients into risk categories are progressing but a consistent, evidence-based system has not yet been developed. Pharmacologic and surgical interventions to prevent and treat this complication have been an area of ongoing research a...
Source: Current Anesthesiology Reports - April 24, 2019 Category: Anesthesiology Source Type: research

Pediatric Obstructive Sleep Apnea: Neurocognitive Consequences
AbstractPurpose of ReviewThis review seeks to highlight the issue of when the best time to operate is given the neurocognitive consequences of pediatric OSA.Recent FindingsLearning and memory deficits persist after adenotonsillectomy in school age children with the disease at 9-month follow-up, suggesting short-term damage to the hippocampus in young children with OSA.SummaryLarger trials with younger children with pediatric OSA are currently ongoing to evaluate the impact of adenotonsillectomy on learning and memory recovery. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - April 22, 2019 Category: Anesthesiology Source Type: research

Fluid Management in Septic Shock: a Review of Physiology, Goal-Directed Therapy, Fluid Dose, and Selection
AbstractPurpose of ReviewTo review our current understanding of the intravascular space, therapeutic goals of fluid resuscitation, suitable endpoints of resuscitation, and appropriate choice of fluids.Recent FindingsAn evolving understanding of the endothelium and glycocalyx has improved our understanding of the intravascular space. More aggressive fluid resuscitation after adoption of the Surviving Sepsis Campaign guidelines has led to an initial reduction in mortality associated with sepsis; however, the untoward effects of volume overload are increasingly evident. Fluid responsiveness is likely the best endpoint for res...
Source: Current Anesthesiology Reports - April 22, 2019 Category: Anesthesiology Source Type: research

Paravertebral Blocks: Anatomical, Practical, and Future Concepts
This article aims to review the thoracic paravertebral block by discussing the relevant anatomy, and landmark and ultrasound-guided techniques. We will compare analgesic efficacy to established neuraxial techniques as well as discuss the complications.Recent FindingsThe quality of analgesia is comparable and non-inferior to epidural analgesia, especially for surgery involving a thoracotomy. The evidence regarding its use in abdominal surgery is not clear. There are long-term analgesic benefits for thoracic paravertebral blocks in breast surgery and it might potentially play a role in modulating cancer recurrence. Furthermo...
Source: Current Anesthesiology Reports - April 11, 2019 Category: Anesthesiology Source Type: research

How Does Frailty Affect ICU Outcome?
AbstractPurpose of the ReviewFrailty as a concept has been developed a lot during the last 25  years. From its start in geriatrics, its usefulness has also been demonstrated in most other clinical specialties including anesthesia, surgery, and intensive care. Several tools have been found useful to characterize frailty status: frailty phenotype, clinical frailty scale, or specific scores fo r surgical patients. The purpose of this review is to discuss how frailty interactive with acute critical illness and may alter ICU outcomes, particularly in the old patients.Recent FindingsFrailty has in many studies been found to...
Source: Current Anesthesiology Reports - April 1, 2019 Category: Anesthesiology Source Type: research

Perioperative Oxygenation Targets in Adults
AbstractPurpose of ReviewOxygen therapy is administered liberally to give a margin of safety against life-threatening hypoxia; however, excessive supplementary oxygen may increase the risk of serious adverse events with a potential negative impact on both morbidity and mortality. This review focuses on the current evidence and emerging data relating to oxygen therapy in the perioperative setting.Recent FindingsCurrent controversies around evidence-based guidelines for perioperative oxygen therapy present a serious challenge for anesthetists. Recommendations vary from very high fractions of inspired oxygen for prevention of...
Source: Current Anesthesiology Reports - April 1, 2019 Category: Anesthesiology Source Type: research

Current Concepts in the Management of the Difficult Pediatric Airway
AbstractPurpose of ReviewThe goal of this paper is to review key concepts in the management of the pediatric difficult airway. Early recognition of risk factors and thorough preparation may be helpful in reducing the risk of complications during airway management.Recent FindingsManagement of difficult pediatric airway management may be associated with a high rate of complications. It is important that clinicians understand the patient profiles associated with difficult airway management and the equipment and techniques available to effectively manage these children. Airway ultrasonography and apneic oxygenation are novel t...
Source: Current Anesthesiology Reports - March 28, 2019 Category: Anesthesiology Source Type: research

An Updated Review on Liposome Bupivacaine
AbstractPurpose of ReviewIn this review, we discuss the evidence for the use of liposome bupivacaine during the perioperative period when used for surgical site infiltration or as part of a peripheral/epidural nerve block.Recent FindingsThere is sparse high-quality evidence from randomized controlled trials that liposome bupivacaine is superior to traditional bupivacaine when surgically infiltrated. The evidence for liposome bupivacaine used as part of peripheral and epidural nerve blocks is promising, but its superiority is yet to be determined when compared to single-injection or continuous perineural infusions using une...
Source: Current Anesthesiology Reports - March 26, 2019 Category: Anesthesiology Source Type: research

Inotropes and Vasoactive Agents: Differences Between Europe and the United States
AbstractPurpose of ReviewThis review focuses on the place of vasoactive agents in the treatment of shock. We will discuss evidence and compare available guidelines and current treatment patterns between Europe and the United States (US).Recent FindingsRetrospective data from large registries demonstrated a wide variability between physicians and hospitals in the use of vasoactive agents in the treatment of shock, especially with regard to inotropes. This is due to a paucity of evidence-based data and hence a lack of clear recommendations on how to choose one agent over another. Norepinephrine has replaced dopamine as the f...
Source: Current Anesthesiology Reports - March 25, 2019 Category: Anesthesiology Source Type: research

Transfusion Requirements in Anesthesia and Intensive Care
AbstractPurpose of ReviewAllogeneic blood products are commonly used in perioperative and critically ill patients. This review focuses on the current evidence and emerging data relating to modern transfusion strategies in these patients.Recent FindingsSeveral large randomized trials and meta-analyses found no inferiority of a restrictive strategy as compared to a liberal one in red blood cell (RBC) transfusion. The storage duration of transfused RBC seems to have a minor, if any, impact on patients ’ outcome. However, patients requiring massive transfusions might be an exception. The indications and benefits of plasm...
Source: Current Anesthesiology Reports - March 23, 2019 Category: Anesthesiology Source Type: research

Septic Shock and the Heart
AbstractPurpose of ReviewThe aim of this review is to analyze the cardiovascular pathophysiology of septic shock. Using visual representations of a left ventricular cycle in the pressure/volume plane, we describe hemodynamic derangement occurring in septic shock and subsequent changes at each step of treatment allowing a rapid understanding of complex alterations.Recent FindingsAcute circulatory failure during sepsis has to be counterbalanced rapidly and appropriately. The most recent guidelines rely on volume expansion, vasoactive, and inotropic support but underlining patients ’ pathophysiology is often undetermine...
Source: Current Anesthesiology Reports - March 21, 2019 Category: Anesthesiology Source Type: research

Renal Replacement Therapy in Critical Care: When to Start?
AbstractPurpose of ReviewAside from absolute indications, the optimal timing of renal replacement therapy (RRT) in critical care is unknown. In this review, we discuss initiation of RRT in relation to both severity of acute kidney injury (AKI) and fluid accumulation.Recent FindingsResults from studies of early vs. late RRT are conflicting, and no definitive conclusions have been made. Observational data points to fluid accumulation as a detrimental factor in critical illness and recent studies have shown that early fluid removal with RRT is feasible and could potentially improve survival.SummaryThere is a gap in the knowle...
Source: Current Anesthesiology Reports - March 19, 2019 Category: Anesthesiology Source Type: research

Pediatric Post-anesthesia Care Unit Challenges Update
AbstractPurpose of ReviewThe purpose of this review is to discuss the current management of various challenges the health care provider faces in the pediatric post-anesthesia care unit (PACU).Recent FindingsEfforts to ameliorate and manage PACU issues in the pediatric patient continue to evolve as new medications and methods of anesthesia delivery are introduced and incorporated into the perioperative period. In this review, emergence delirium (ED), postoperative nausea and vomiting (PONV), residual neuromuscular blockade, and tracheal extubation in the operating room versus the PACU are addressed. As ED may be self-limite...
Source: Current Anesthesiology Reports - March 2, 2019 Category: Anesthesiology Source Type: research

A Review of Anesthesia Simulation in Low-Income Countries
AbstractPurpose of ReviewAnesthesia workforce gaps in low- and middle-income countries (LMICs) can hinder safe surgical care. Several countries have fewer than one anesthesiologist per million population and some have fewer than two anesthesiologists nationally. Limited apprenticeship opportunities and inadequate supervision present serious challenges in these locations. Although simulation training could help disseminate expert guidance, the high cost, technical challenges, and varied approaches limit application. We reviewed the literature on cost-efficient and effective simulation training programs for anesthesia workfo...
Source: Current Anesthesiology Reports - February 28, 2019 Category: Anesthesiology Source Type: research

Pediatric Regional Anesthesia Advances
AbstractPurpose of ReviewTo present recent developments in pediatric regional anesthesia (RA) including safety, complications, special populations, evidence-based trends, and ultrasound guidance. The data presented should be used to improve outcomes of children receiving RA.Recent FindingsCurrent data demonstrates a very low occurrence of serious complications and validates the use of GA for block placement in children. Fewer neuraxial blocks are performed in favor of peripheral blocks as the use of ultrasound guidance has made new blocks possible and old blocks better and safer. Neonates and infants have more RA options. ...
Source: Current Anesthesiology Reports - February 28, 2019 Category: Anesthesiology Source Type: research

Pharmacologic Treatment of Insomnia in Children and Adolescents with Chronic Pain Conditions
AbstractPurpose of ReviewThe purpose of this chapter is to provide a review and expert opinion supporting pharmacological treatments for insomnia in children and adolescents with chronic pain conditions.Recent FindingsInsomnia as an independent disorder is defined as dissatisfaction with sleep quantity or quality, clinically significant distress or impairment in daytime functioning, and a specific time pattern of occurrence. Independent of the pathological context, insomnia is more frequent in adolescents than in children. The impact of insomnia on pediatric patients is quite profound, especially on those affected by chron...
Source: Current Anesthesiology Reports - February 22, 2019 Category: Anesthesiology Source Type: research

How Do We Know? Comparisons of Existing Datasets for Overseas Surgical Missions
AbstractPurpose of ReviewOver five billion people lack access to safe surgery when they need it. Short-term surgical missions from high-resource countries are a popular strategy to try and address this deficit. Each year, thousands of providers spend billions of dollars participating in short-term surgical missions. These missions are poorly characterized in aggregate. In this exercise, we performed reviews of two databases in an attempt to identify and characterize short-term surgical missions to Uganda. The first, a traditional search of the medical literature. The second, an unorthodox search of the internet. We compare...
Source: Current Anesthesiology Reports - February 19, 2019 Category: Anesthesiology Source Type: research

Anesthetic Management of Nonobstetric Surgery during Pregnancy
This article reviews several controversial aspects of management of nonobstetric surgery during pregnancy, including the optimal timing for nonurgent surgery, when to perform intraoperative fetal monitoring, modifications to anesthetic techniques to account for the physiologic changes of pregnancy, and management of maternal cardiac arrest.Recent FindingsThere have been several advances in the management of nonobstetric surgery during pregnancy, including the increased use of laparoscopic techniques, an improved understanding of the importance of adequate pain management, and new initiatives to improve the maternal cardiac...
Source: Current Anesthesiology Reports - February 19, 2019 Category: Anesthesiology Source Type: research

Update on Obstetric Hemorrhage
AbstractPurpose of ReviewPostpartum hemorrhage is increasing in prevalence in the USA and continues to be an important cause of preventable maternal morbidity and mortality. This review provides the most recent epidemiologic data on postpartum hemorrhage in the USA, current nationwide initiatives for prevention, preparedness, and response to postpartum hemorrhage, and recent evidence-based advances in management.Recent FindingsThe National Partnership for Maternal Safety consensus bundle on obstetric hemorrhage serves as a resource for postpartum hemorrhage –related clinical and research initiatives. Areas of focus i...
Source: Current Anesthesiology Reports - February 19, 2019 Category: Anesthesiology Source Type: research

Hurdles to the Development of the “Surgical Home” in the Low-Resource World
AbstractPurpose of ReviewThis chapter assesses the current state of practice of anesthesia in a low-resourced hospital and the hurdles envisaged in the development of perioperative surgical home, PSH, at the Komfo Anokye Teaching Hospital, KATH in Ghana.Recent FindingsIn the PSH model, the patient ’s experience of care is coordinated by a Director of Perioperative Services, additional Surgical Home Leadership, and supportive personnel, which constitute an interdisciplinary team. KATH is yet to establish working structures that provide a solid foundation that would make implementation of thi s model possible. Foundati...
Source: Current Anesthesiology Reports - February 1, 2019 Category: Anesthesiology Source Type: research

Inhaled Nitrous Oxide Analgesia for Labor
AbstractPurpose of ReviewThis paper reviews the history, efficacy, safety, and administrative concerns for nitrous oxide analgesia during labor.Recent FindingsWhile pain relief is inferior to that provided by neuraxial analgesia, maternal satisfaction is equivalent to that of neuraxial techniques, and better if analgesia is reported to be poor. A recent systematic review reports good safety for mother and child, that some women report excellent pain relief and others not, and that minor side effects are infrequent. Qualitative research summarizing patient comments on their experience suggests that numerous factors other th...
Source: Current Anesthesiology Reports - January 31, 2019 Category: Anesthesiology Source Type: research

Update on Vasopressors for Cesarean Delivery
AbstractPurpose of ReviewThe aim of this article is to provide an overview of the current strategies for managing spinal-induced hypotension during cesarean delivery with a particular focus on the evidence guiding the use of vasopressors.Recent FindingsPhenylephrine is currently regarded as the first-line vasopressor in the prevention and treatment of spinal-induced hypotension following evidence that supports a favorable effect on neonatal acid-base status as well as reduced incidences of nausea and vomiting when compared with ephedrine. Norepinephrine and metaraminol are also effective in the prevention and treatment of ...
Source: Current Anesthesiology Reports - January 31, 2019 Category: Anesthesiology Source Type: research

Maternal Sepsis: Recognition, Treatment, and Escalation of Care
AbstractPurpose of ReviewThe purpose of this article is to provide a brief review of maternal sepsis and the supporting literature for recognition and management.Recent FindingsRecent findings suggest that there is significant room for improvement in identifying patients at risk, expeditiously providing appropriate intervention, and developing action plans to best care for these patients and prevent morbidity and mortality.SummaryImproved education and understanding of the unique presentation of sepsis during pregnancy may help to improve detection, timely treatment, and expedite appropriate transfer to higher levels of ca...
Source: Current Anesthesiology Reports - January 26, 2019 Category: Anesthesiology Source Type: research

A Philosophical Primer for Your First Global Anesthesia Experience
AbstractPurpose of ReviewThere are few publications regarding practical important philosophical considerations to international anesthesia work. Most of the literature in this realm is aimed at trainees or are logistical recommendations.Recent FindingsClarity of mission can provide guidance and benchmarks for managing challenging situations that may unduly influence the overall experience of a global health trip. Much of that clarity can come from authentic exchanges with your colleagues from the under-resourced region in question.SummaryWe intend to provide a framework and some core principles for organizing thoughts and ...
Source: Current Anesthesiology Reports - January 22, 2019 Category: Anesthesiology Source Type: research

Anesthetic Considerations in the Care of the Parturient with Obesity
AbstractPurpose of ReviewThe goal of this review is to summarize recent findings on the physiologic alterations posed by maternal obesity and implications for the anesthetic care of mother and infant.Recent FindingsObesity is rising nationally and globally. Many studies show associations between excess weight during pregnancy with increased morbidity and mortality. Parturients with obesity are at a higher risk of endocrine, cardiac, pulmonary, and post-operative complications. A neuraxial catheter is recommended given the higher risk of an operative delivery. Consultation by an obstetric anesthesiologist is helpful for pat...
Source: Current Anesthesiology Reports - January 18, 2019 Category: Anesthesiology Source Type: research

Respiratory and Airway Considerations in Obstetric Patients
AbstractPurpose of ReviewThe purpose of this article is to provide the current evidences on respiratory and airway medicine in the obstetric population.Recent FindingsThe prevalence of obstructive sleep apnea (OSA) among pregnant women is increasing. Upper body elevation improves respiratory mechanics in parturients and reduces the risk of postpartum OSA. Clinically significant respiratory depression from neuraxial opioid administration, compared to parenteral, is extremely rare.The incidence of failed tracheal intubation in obstetric patients is higher than that in non-obstetric patients and it has been unchanged recently...
Source: Current Anesthesiology Reports - January 18, 2019 Category: Anesthesiology Source Type: research

Development of Intensive Care in Low-Resource Regions
AbstractPurpose of reviewSince their introduction almost a century ago, intensive care units have become an essential part of the health care system. Although the majority are found in the high-income countries, access to intensive care in the low-income countries has improved. The purpose of this review is to report on the current state of intensive care in resource-limited settings.Recent FindingsLack of basic health care resources still poses a specific challenge to the development and sustainability of health care. In addition, adequate funding, human resource training, and equipment specific to the specialty of critic...
Source: Current Anesthesiology Reports - January 18, 2019 Category: Anesthesiology Source Type: research

New Cancer Therapies: Implications for the Perioperative Period
AbstractPurpose of ReviewCancer is on the rise. Standing on verge of exciting discoveries, research is being translated into therapies that are being widely administered to patients. Providing a hope for cure, where none existed before. This new body of knowledge has come from a better understanding of cancer genetics, molecular and sub molecular behavior, and understanding of cancer-generated cellular environments. These have led to development of immunotherapy and its many sub-genres, improvement and introduction of new radiation technologies, and decreasing toxicities of existing chemotherapies.Recent FindingsThe purpos...
Source: Current Anesthesiology Reports - December 6, 2018 Category: Anesthesiology Source Type: research

Cancer Biology: a Primer for Perioperative Clinicians
AbstractPurpose of ReviewCancer biology is a field that has grown exponentially in the last several decades. Elucidating the mechanisms involved in tumor development, while broadening our understanding, continues to reveal unexplained phenomena. Attempting to understand cancer biology requires a framework from which to start; two landmark reviews from 2000 and 2011 by Hanahan and Weinberg present such a framework. With advances in cancer therapeutics, an appreciation of the underlying tumor biology is necessary to optimally care for patients in the perioperative period. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - November 12, 2018 Category: Anesthesiology Source Type: research

Perioperative Stress, Inflammation, and Cancer Progression: Opportunities for Intervention in Breast and Colorectal Cancer Surgery Utilizing Beta-Adrenergic Blockade and COX-2 Inhibition
AbstractPurpose of reviewThis review explores the blockade of cyclooxygenase (COX)-2/prostaglandin and catecholamine/beta( β)-adrenergic signaling as opportunities to enhance the curative potential of surgical excision of breast and colorectal cancer malignancies.Recent findingsPhase-II randomized placebo-controlled biomarker clinical trials, employing perioperative administration of the COX-2 inhibitor etodolac and the β-adrenergic antagonist propranolol, have shown improved biomarkers associated with both breast and colorectal cancer progression. Tumor epithelial-to-mesenchymal transition (EMT) status and tumor...
Source: Current Anesthesiology Reports - November 8, 2018 Category: Anesthesiology Source Type: research

Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications
AbstractPurpose of ReviewThe aging, sedentary global population and associated increasing incidence of cancer calls for increasingly complex surgery. These patients are at particular risk of postoperative complications. This review will explore the redesign of the perioperative care pathway, with emphasis on preoperative risk stratification to identify modifiable risk, to implement risk mitigation strategies (e.g., prehabilitation), and to partner with patients to enhance recovery after surgery.Recent FindingsIn the last decade, there has been a growing body of literature surrounding prehabilitation. A number of these stud...
Source: Current Anesthesiology Reports - November 6, 2018 Category: Anesthesiology Source Type: research

Cancer Tsunami: Emerging Trends, Economic Burden, and Perioperative Implications
AbstractPurpose of ReviewThis review discusses global trends in cancer mortality and survival, the socioeconomic drivers of those trends, and recent innovations in cancer surgery.Recent FindingsCancer is a leading cause of death worldwide. Cancer, previously a disease primarily of wealthy countries, is rapidly becoming a leading cause of death in low- and middle-income countries. Major economic forces driving global cancer trends include aging, frailty, and obesity. Alcohol consumption, poor diet, and lack of exercise also contribute to cancer types associated with modifiable causes. Surgery is responsible for 65% of cance...
Source: Current Anesthesiology Reports - November 6, 2018 Category: Anesthesiology Source Type: research

Propofol (TIVA) Versus Volatile-Based Anesthetics: Is There Any Oncological Benefit?
AbstractPurpose of ReviewTo summarize the most recent available clinical and pre-clinical research data concerning the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on oncological outcomes and to discuss the biological basis by which these drugs are purported to exert effects on the cancer cell and on the host.Recent FindingsRecent retrospective analyses of clinical datasets have generated considerable interest in the hypothesis that the two major classes of general anesthetics in clinical use for oncological surgery —namely inhalational fluranes and intravenous propofol—...
Source: Current Anesthesiology Reports - November 3, 2018 Category: Anesthesiology Source Type: research

The Effect of Anaesthetic and Analgesic Technique on Oncological Outcomes
AbstractPurpose of ReviewThe purpose of this review is to provide an examination of the recent literature relating to anaesthesia and analgesia for cancer surgery and their potential effects on cancer recurrence and metastasis.Recent FindingsOpioids continue to have mixed results in terms of their long-term effects on cancer outcomes. While laboratory evidence suggests alterations in immune responses and pro-tumourigenic effects via opioid receptors on cancer cells, clinical evidence is lacking. Regional anaesthesia has the ability to regulate surgical stress response, but retrospective studies provide conflicting results....
Source: Current Anesthesiology Reports - October 30, 2018 Category: Anesthesiology Source Type: research

Local Anesthetics (LAs) and Cancer Cell Progression: Is There an Oncologic Protective Role for LAs in Clinical Practice?
AbstractPurpose of ReviewThe purpose of this article is to provide a brief review of current literature examining the potential oncologic protective role local anesthetics may provide in the perioperative setting during cancer surgery.Recent FindingsParadoxically, curative surgery for cancer appears to favor the development of recurrences and distant metastasis. The accumulated knowledge about cancer biology and our understanding of the pathophysiological events occurring during the perioperative period have opened several theories on potential mechanisms for this century old observation. In such, cell-mediated immune resp...
Source: Current Anesthesiology Reports - October 28, 2018 Category: Anesthesiology Source Type: research

New Advances in Neuromodulation
AbstractPurpose of ReviewThe purpose of this article is to illustrate the recent advances made in the field of neuromodulation for chronic pain management and it provides a brief review of the literature supporting their safe and efficacious use.Recent FindingsSpinal cord stimulation (SCS) has been an effective therapy for the management of intractable pain conditions including complex regional pain syndrome (CRPS), peripheral neuropathy, and failed back surgery syndrome (FBSS). With the introduction of high-frequency and burst SCS waveforms, there has been a noted improvement in the treatment outcomes of these pain syndro...
Source: Current Anesthesiology Reports - October 24, 2018 Category: Anesthesiology Source Type: research