Postoperative Delirium
AbstractPurpose of ReviewThis review is aimed to provide an up-to-date summary of the diagnosis, risk factors, and management of postoperative delirium (POD) with a focus on latest evidence-based clinical studies.Recent FindingsThere is strong association between POD and long-term cognitive decline. Among the various alternatives, Confusion Assessment Method (CAM) remains the most common screening tool for POD diagnosis. Preoperative anemia and hyperglycemia are additional independent risk factors of POD. Multicomponent non-pharmacological interventions are effective in decreasing the occurrence of POD. Dexmedetomidine and...
Source: Current Anesthesiology Reports - May 8, 2021 Category: Anesthesiology Source Type: research

Dexmedetomidine in Modern Neuroanesthesia Practice
AbstractPurpose of ReviewThe purpose of this review is to discuss the role of dexmedetomidine in various procedures in clinical neurosciences. It also gives an overview of the various neurosurgical procedures where dexmedetomidine has been used perioperatively.Recent FindingsDexmedetomidine possesses many properties that are advantageous for neurosurgical patient including its neuroprotective effect. Its role in the cerebral vasospasm has recently become an area of interest for the researchers. There are number of animal as well as human studies where authors observed an improved neurological outcome following administrati...
Source: Current Anesthesiology Reports - May 7, 2021 Category: Anesthesiology Source Type: research

Anesthesia for Endovascular Neurosurgery
AbstractPurpose of ReviewThis review considers important aspects in the provision of anesthesia for endovascular neurosurgery. Subject literature was reviewed to include important publications which have influenced neuro-interventional practice alongside recent meta-analyses to provide a contemporaneous evidence-based review.Recent FindingsThe scope of endovascular neurosurgery and interventional neuro-radiology continues to expand. The advancement of catheter and imaging technologies, alongside the development of novel techniques, has allowed a minimally invasive endovascular approach to be applied to pathologies previous...
Source: Current Anesthesiology Reports - May 6, 2021 Category: Anesthesiology Source Type: research

Author Correction: Pharmacologic Prevention and Treatment of Postpartum Hemorrhage
A Correction to this paper has been published:https://doi.org/10.1007/s40140-021-00449-2 (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - April 28, 2021 Category: Anesthesiology Source Type: research

Sedation in the Intensive Care Unit
AbstractPurpose of ReviewThis narrative review illustrates literature over the last 5 years relating to sedation delivery to mechanically ventilated adult patients in intensive care units.Recent FindingsThere has been an increase in dexmedetomidine-related publications but although systematic reviews suggest dexmedetomidine reduces delirium, agitation, and length of stay, clinical trials have not supported these findings. It is likely to be useful for the managing patients with persisting agitation. Guidelines continue to recommend lightly sedating patients but considerable variation remains in clinical practice and in res...
Source: Current Anesthesiology Reports - April 24, 2021 Category: Anesthesiology Source Type: research

Airway Management in the Critically Ill Patient
AbstractPurpose of ReviewThis paper will evaluate the recent literature and best practices in airway management in critically ill patients.Recent FindingsCardiac arrest remains a common complication of intubation in these high-risk patients. Patients with desaturation or peri-intubation hypotension are at high risk of cardiac arrest, and each of these complications have been reported in up to half of all intubations in critically ill patient populations.SummaryThere have been significant advances in preoxygenation and devices available for performing laryngoscopy and rescue oxygenation. However, the risk of cardiovascular ...
Source: Current Anesthesiology Reports - April 19, 2021 Category: Anesthesiology Source Type: research

Anesthesia for Acute Ischemic Stroke: Updates and Ongoing Debates
AbstractPurpose of ReviewAdvancements in stroke therapeutics and endovascular therapy in the last decade have dramatically changed the management of acute ischemic stroke, the structure of stroke care pathways, and demand for anesthesia resources. This review outlines the evolving perspectives on anesthetic management for the thrombectomy patient, including areas of debate, current recommendations, and future directions for research.Recent FindingsKey concepts in stroke care include immediate medical attention, emergent transfer to a stroke facility, physiologic and hemodynamic stabilization, and rapid recanalization. Alth...
Source: Current Anesthesiology Reports - April 8, 2021 Category: Anesthesiology Source Type: research

Pharmacologic Prevention and Treatment of Postpartum Hemorrhage
AbstractPurpose of ReviewThe purpose of this review is to synthetize the latest evidence on the pharmacological management of postpartum hemorrhage (PPH) and apply it to the clinical context.Recent FindingsThe incidence of PPH in the developed world is rising. Oxytocin and its analogue carbetocin remain the number one choice as first-line uterotonics for the prevention of PPH due to excellent clinical efficacy and a favorable side effect profile. Doses of oxytocin and carbetocin currently recommended for prophylaxis are in excess to that required for clinical efficacy. There is no robust evidence suggesting that one second...
Source: Current Anesthesiology Reports - March 29, 2021 Category: Anesthesiology Source Type: research

Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome
AbstractPurpose of ReviewTo review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously.Recent FindingsObservational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpubl...
Source: Current Anesthesiology Reports - March 3, 2021 Category: Anesthesiology Source Type: research

Enhanced Recovery After Cesarean: Current and Emerging Trends
AbstractPurpose of ReviewWhat are the latest enhanced recovery elements for cesarean delivery?Recent FindingsEnhanced recovery after cesarean delivery (ERAC) provides an evidenced-based system to improve maternal outcomes, functional recovery, maternal-infant bonding, and patient experience. Postsurgical recovery has evolved from a one-dimensional pain score to a holistic multidimensional approach emphasizing faster functional recovery. ERAC involves multidisciplinary efforts of the anesthesiologist, obstetrician, nursing, hospital, and patient. Components of ERAC include preoperative patient education, limited fasting, ca...
Source: Current Anesthesiology Reports - March 2, 2021 Category: Anesthesiology Source Type: research

High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review
AbstractPurpose of ReviewThis review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic.Recent FindingsGlobally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive s...
Source: Current Anesthesiology Reports - March 2, 2021 Category: Anesthesiology Source Type: research

Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review
AbstractPurpose of ReviewTo highlight the challenges associated with providing sedation and analgesia to critically ill patients with coronavirus disease 2019 (COVID-19) and also understand the pathophysiological alterations induced by the disease process as well as the logistical difficulties encountered by providers caring for these patients. We also discuss the rationale and risks associated with the use of common sedative agents specifically within the context of COVID-19 and provide evidence-based management strategies to help manage sedation and analgesia in such patients.Recent FindingsA significant proportion of pa...
Source: Current Anesthesiology Reports - February 26, 2021 Category: Anesthesiology Source Type: research

Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance
This article aims to describe the role of anesthesiologists on current standards of infection prevention and sterility as well as ongoing developments in resource-limited settings, with a focus on LMICs.Recent FindingsRecent estimates indicate a threefold increase in the incidence of SSI across LMICs over the past two decades, approaching two times the estimated SSI incidence of high-income countries. As a result, public health officials have promoted standard practices for infection prevention in the surgical arena by creating multidisciplinary teams and tailoring to the availability of equipment and resources. Anesthesio...
Source: Current Anesthesiology Reports - February 26, 2021 Category: Anesthesiology Source Type: research

Perioperative Management of Severe Acquired Coagulopathy in Patients with Left Ventricular Assist Device —a Literature Review and Expert Recommendations
AbstractPurpose of This ReviewThe implantation of a left ventricular assist device (LVAD) is associated with high hemorrhage-related re-exploration rates. Improved management of coagulopathy may improve patient outcome. The optimal management of acquired coagulopathy in LVAD patients needing urgent non-cardiac surgery needs to be defined. We aim to review risk factors for perioperative bleeding and diagnosis and management of LVAD-associated coagulopathy and to provide expert recommendations for clinical practice.Recent FindingsIn patients undergoing LVAD implantation, the severity of coagulopathy is directly related to th...
Source: Current Anesthesiology Reports - February 24, 2021 Category: Anesthesiology Source Type: research

The Current Role of General Anesthesia for Cesarean Delivery
AbstractPurpose of the ReviewThe use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this rev...
Source: Current Anesthesiology Reports - February 24, 2021 Category: Anesthesiology Source Type: research

The Role of Truncal Blocks in Obstetric Anesthesia
AbstractPurpose of ReviewThis review provides a framework for managing post-cesarean delivery pain in the age of enhanced recovery after surgery (ERAS). In doing so, it highlights the role that truncal blocks play in obstetric anesthesia. The value of transversus abdominus plane block (TAP) and quadratus lumborum block (QLB) to optimize post-cesarean delivery pain is discussed.Recent FindingsTAP block and QLB have been compared with each other and with controls, with and without neuraxial morphine. In the absence of neuraxial morphine, TAP block and QLB are superior to controls, but when intrathecal morphine is used, they ...
Source: Current Anesthesiology Reports - February 18, 2021 Category: Anesthesiology Source Type: research

Drug Shortages in Obstetrics
AbstractPurpose of ReviewThis review highlights the patient safety and practice management concerns surrounding drug shortages in obstetric anesthesiology. Given the lack of evidence-based strategies for managing shortages, this review was created to provide societal consensus suggestions and practical guidance to assist clinicians in creating safe systems for medication administration in the obstetric unit.Recent FindingsDrug shortages occur for a variety of reasons but may pose significant risk to patients as they may be more likely to receive suboptimal therapy or even experience harm due to medication errors.SummaryMin...
Source: Current Anesthesiology Reports - January 28, 2021 Category: Anesthesiology Source Type: research

Distance-Learning Initiatives Targeting Non-physician Anesthesia Providers in Low-Resource Environments
AbstractPurpose of Review“Distance-learning” encompasses a variety of didactics, from self-directed online learning to focused courses and programs. Despite increasing internet availability, focused distance-learning courses are rarely practiced in low- or middle-income countries, particularly among non-physician anesth etists. This review aims to discuss the availability, significance, and challenges of distance-learning programs for non-physician anesthesia providers in low-resource settings.Recent FindingsTask shifting and sharing in anesthesia remains essential in low-resource settings to meet the demand of...
Source: Current Anesthesiology Reports - January 26, 2021 Category: Anesthesiology Source Type: research

The Comparability and Utility of Perioperative Mortality Rates in Global Health
AbstractPurpose of ReviewTo examine the comparability and utility of perioperative mortality rate (POMR) as a key global surgery metric and the added potential for mortality review to drive continuous quality improvement.Recent FindingsThere is a wide variation in the perioperative mortality rate (POMR) reported between countries, even for the three Bellwether procedures (emergency laparotomy, emergency caesarean section, management of an open fracture) and other common procedures. Clinical registries such as the National Emergency Laparotomy Audit target high-mortality procedures. Nationally, administrative databases may ...
Source: Current Anesthesiology Reports - January 21, 2021 Category: Anesthesiology Source Type: research

Task Sharing in Global Anesthesia and Surgery: Workforce Concerns
AbstractPurpose of ReviewThis review highlights the role of task sharing in temporarily solving the human resource crisis in anesthesia and surgery in low- and middle-income countries (LMICs) while emphasizing the need for these countries to increase the workforce of anesthesiologists and surgeons as a permanent solution.Recent FindingsDespite the obvious need for specialists to provide safe anesthesia and surgery in the LMICs, there is still a critical shortage of skilled personnel to fill this gap. Task sharing and task shifting are temporary solutions to this crisis but continue to be a challenge. Even with such measure...
Source: Current Anesthesiology Reports - January 8, 2021 Category: Anesthesiology Source Type: research

Unique Pain Management Needs for Pregnant Women with Pre-existing PTSD and Other Mental Health Disorders
AbstractPurpose of ReviewThis review describes how the presence of maternal mental health disorders influences peripartum pain. It provides practical guidance for tailored anesthetic plans that address the unique needs of pregnant women with such disorders.Recent FindingsThe role of maternal mental health conditions in the peripartum experience and postpartum course for the mother-baby dyad is an evolving area of interest in the current psychiatric and obstetric literature. It is only recently, however, that providers are beginning to understand how pre-existing maternal posttraumatic stress disorder (PTSD), anxiety, or de...
Source: Current Anesthesiology Reports - January 7, 2021 Category: Anesthesiology Source Type: research

Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries
AbstractPurpose of ReviewThis review highlights the applications of point-of-care ultrasound in low- and middle-income countries and shows the diversity of ultrasound in the diagnosis and management of patients.Recent FindingsThere is a paucity of data on point-of-care ultrasound in anesthesiology in low- and middle-income countries. However, research has shown that point-of-care ultrasound can effectively help manage infectious diseases, as well as abdominal and pulmonary pathologies.SummaryPoint-of-care ultrasound is a low-cost imaging modality that can be used for the diagnosis and management of diseases that affect low...
Source: Current Anesthesiology Reports - January 6, 2021 Category: Anesthesiology Source Type: research

Prescribing Opioids: Universal Education on Opioid Use, Storage, and Disposal
This article highlights the challenges in opioid prescribing and provides guidance on patient education for opioid safety, storage, and disposal as well as recommendations for cautious prescribing for a patient with cancer.Recent FindingsAmid the opioid crises, multiple groups have reported that there is a gap in knowledge among patients and prescriber on proper opioid use, storage, and disposal that contributes to unsafe opioid practices.SummaryOpioids are important in the treatment of pain in majority of patients with advanced cancer. Clinicians managing cancer-related pain have faced significant challenges in safely pre...
Source: Current Anesthesiology Reports - November 26, 2020 Category: Anesthesiology Source Type: research

Awareness with Recall After Neuromuscular Blockade —Lessons on Anesthetic Awareness from the UK and Ireland National Audit Project 5 (NAP5)
AbstractPurpose of ReviewThis review will summarize the current understanding of awareness with recall (AWR) after general anesthesia and draw ten lessons on its prevention and management from the largest study of AWR, the UK and Ireland National Audit Project 5 (NAP5).Recent FindingsThe results of NAP5 were published in 2014 and resulted in practice guidance on the prevention and management of AWR, “The NAP5 Handbook” which was published in 2019. NAP5 also led to the Guidelines for the Safe Practice of Total Intravenous Anaesthesia (TIVA) which were produced by the Association of Anaesthetists and the Society ...
Source: Current Anesthesiology Reports - November 23, 2020 Category: Anesthesiology Source Type: research

Perioperative Pain Control in the Opioid-Dependent Patient: Just Bite the Bullet?
AbstractPurpose of ReviewThe opioid crisis in the USA makes it very likely that a large number of patients who are opioid-dependent will require surgical procedures. Perioperative pain control in those patients poses a formidable challenge to the surgical and anesthesia care team. Previously, patients received only additional opioids to cover the postoperative pain and would then be referred back to their primary care physician with often escalation of opioid dosing.Recent FindingsVarious strategies and recommendations to help with postoperative pain control in these challenging situations are available and can be applied ...
Source: Current Anesthesiology Reports - November 3, 2020 Category: Anesthesiology Source Type: research

Airway Management of the Obstetric Patient
AbstractPurpose of ReviewThe purpose of this article is to provide current evidence and review guidelines regarding obstetric airway management.Recent FindingsVideo laryngoscopy (VL) is gaining popularity in obstetric airway management as a primary technique and a rescue technique. Both humidified and high flow nasal cannula (HFNC) are being used for the obstetric difficult airway (DA). Continuing general anesthesia (GA) after successful supraglottic airway (SGA) placement requires awareness and proficiency with different SGAs and SGA-guided flexible bronchoscopic tracheal intubation (SGAFBI). Use of simulation during trai...
Source: Current Anesthesiology Reports - October 28, 2020 Category: Anesthesiology Source Type: research

Non-operating Room Anesthesia: Is It Worth the Risk?
AbstractPurpose of ReviewNon-operating room anesthesia (NORA) has continued to grow. This review provides recent views on the subject and an overview of specific concerns in specialized NORA applications.Recent FindingsRecent literature has reviewed the data from national databases and found no differences in the outcomes of patients undergoing NORA for procedural interventions as opposed to those patients undergoing surgical procedures. Specific areas may have their own challenges and types of patients; however, creation of a system for evaluating, anesthetizing, and recovering these patient from anesthesia results in sig...
Source: Current Anesthesiology Reports - October 27, 2020 Category: Anesthesiology Source Type: research

Use of Processed Electroencephalography in the Clinical Setting
AbstractPurpose of ReviewProcessed electroencephalography (pEEG) is widely used in clinical practice. Few clinicians utilize the full potential of these devices. This brief review will address the improvements in patient management available from the utilization of all pEEG data.Recent FindingsAnesthesiologists easily learn to recognize raw pEEG patterns that are consistent with an appropriate level of hypnotic effect. Power distribution within the waveform can be displayed in a visual format that identifies signatures of the principal anesthetic hypnotics. Opinion on the benefit of pEEG data in the mitigation of postopera...
Source: Current Anesthesiology Reports - October 23, 2020 Category: Anesthesiology Source Type: research

Author Correction: Airway Management in Out of the Operating Room Environments
The original version of this article unfortunately contained a mistake. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - October 12, 2020 Category: Anesthesiology Source Type: research

Insights into the Neurobiology of Craving in Opioid Use Disorder
AbstractPurpose of ReviewOpioids remain the most potent form of pain relief currently available yet have a high abuse liability. Here we discuss underlying neurobiological changes in opioid use disorder (OUD) that likely contribute to drug craving, which in turn drives continued drug use and relapse.Recent FindingsCraving has emerged as a strong indicator in drug-seeking and relapse. Studies have demonstrated a number of allostatic changes in circuitry that facilitate learning of drug-stimuli relationships, thereby augmenting cue-triggered drug use and relapse.SummaryThis review will focus on key neurobiological changes in...
Source: Current Anesthesiology Reports - September 28, 2020 Category: Anesthesiology Source Type: research

Opioid Prescribing with Take-Home Naloxone: Rationale and Recommendations
AbstractPurpose of ReviewAlthough take-home naloxone is available for prescribing, recommended for certain high-risk patients, and can prevent overdose-related deaths, access to naloxone remains a challenge. This review describes the high-risk population on opioids that benefit from naloxone co-prescription, guidelines, and the current trends in naloxone prescribing, and the barriers faced by all the stakeholders.Recent FindingsOpioid-related overdoses and deaths still occur at critically high numbers. Short-acting opioid antagonists like naloxone can reverse the effect of an overdose in a few minutes. The US Food and Drug...
Source: Current Anesthesiology Reports - September 22, 2020 Category: Anesthesiology Source Type: research

Novel Oxygenation Techniques for Airway Management
AbstractPurpose of ReviewSignificant morbidity is caused by hypoxemic events during procedural sedation, induction for tracheal intubation, and postoperatively after anesthesia in the postoperative care unit. Novel and advanced oxygenation techniques will be discussed to help prevent hypoxemia and improve patient outcome.Recent FindingsASA closed claims outside the operating room showed an increase in oxygen desaturation during moderate to deep sedation with no or conventional oxygenation. Non-invasive positive pressure oxygenation (NPPO) reduces the incidence of oxygen desaturation during procedural sedation, during induc...
Source: Current Anesthesiology Reports - September 22, 2020 Category: Anesthesiology Source Type: research

A Practical Approach to Assessment and Management of Patients at Risk for Non-medical Opioid Use: a Focus on the Patient with Cancer-Related Pain
AbstractPurpose of ReviewOver the past decade, the perception of prescription opioids changed dramatically. Once considered a savior from all types of pain, with few side effects and no celling dose, opioids are now restricted by many states, health insurance companies, and pharmacies. This narrative review aims to synthesize the latest evidence for managing oncology patients at risk for non-medical opioid use (NMOU).Recent FindingsOpioids are effective medications for reducing severe cancer pain, despite their side effects. Screening tools identify high-risk patients, and a nomogram is available, using routine clinical da...
Source: Current Anesthesiology Reports - September 10, 2020 Category: Anesthesiology Source Type: research

The Potential Role of Dual Mechanistic Opioids in Combating Opioid Misuse
AbstractPurposeIn the last years, the consumption of opioid analgesics in western countries, particularly in USA, has dramatically increased, and this rise has been paralleled by a proportional number of opioid-related deaths. To response to this health crisis, opioid guidelines have been developed to reduce the risk of harm related to opioid prescribing. Many activities have been suggested to face opioid epidemic. Clinicians should find a proper balance that meets the patient ’s need for pain relief while minimizing abuse. The aim of this review was to examine the value of so-called dual opioids in this contextRecen...
Source: Current Anesthesiology Reports - September 8, 2020 Category: Anesthesiology Source Type: research

Optimizing Perioperative Use of Opioids: a Multimodal Approach
AbstractPurpose of ReviewThe main purpose of this article is to review recent literature regarding multimodal analgesia medications, citing their recommended doses, efficacy, and side effects. The second part of this report will provide a description of drugs in different stages of development which have novel mechanisms with less side effects such as tolerance and addiction.Recent FindingsMultimodal analgesia is a technique that facilitates perioperative pain management by employing two or more systemic analgesics along with regional anesthesia, when possible. Even though opioids and non-opioid analgesics remain the most ...
Source: Current Anesthesiology Reports - September 6, 2020 Category: Anesthesiology Source Type: research

Ultrasound in Airway Management
AbstractPurpose of ReviewClinical application of ultrasound (US) in airway management has continued to expand and evolve over the years. Our narrative aims to provide an updated summary of the role of airway US in current anesthesia practice, based on evidence published in the recent 5  years.Recent FindingsEvidence continues to support the use of US in identifying the cricothyroid membrane and tracheal interspace for infraglottic airway access. While US shows potential in improving the accuracy of prediction of difficult airways, no standardized scanning protocol has yet to be created. Other promising clinical applic...
Source: Current Anesthesiology Reports - September 6, 2020 Category: Anesthesiology Source Type: research

Management of the Difficult Pediatric Airway
AbstractPurpose of ReviewThis review discusses the most current relevant literature regarding management of the difficult pediatric airway.Recent FindingsPeriodic review of the latest research ensures that anesthesia providers are educated on the most current practices. The review will provide practical evidence to support the use of various devices and techniques, including video laryngoscopy, flexible fiberoptic bronchoscopy, apneic oxygenation, use of neuromuscular blockade, ultrasound, and more. A simple algorithm for managing the difficult pediatric airway is also provided. Understanding the risk factors for the diffi...
Source: Current Anesthesiology Reports - September 4, 2020 Category: Anesthesiology Source Type: research

Extubation of the Challenging or Difficult Airway
AbstractPurpose of ReviewThis review explores relevant definitions, epidemiology, management, and potential future research directions in the extubation of the challenging/difficult airway. It provides guidance on identifying patients at risk and how to approach these clinical scenarios.Recent FindingsBased on recent literature, including large-scale audits and closed claims analysis, it is increasingly recognized that extubation of the difficult airway is a situation at risk of severe adverse events. Some strategies to manage the extubation of the challenging/difficult airway have been described.SummaryExtubating the chal...
Source: Current Anesthesiology Reports - September 3, 2020 Category: Anesthesiology Source Type: research

Distractions in the Operating Room
AbstractPurpose of ReviewThe goal of this review is to investigate current research in the area of operating room (OR) distractions, in particular, from the perspective of the anesthesia provider. Additionally, the concept of the “sterile cockpit” is discussed as well as the science of attention span in humans.Recent FindingsEtiology of distractions may be classified as patient care related, due to technology, noise, and alarms, from interpersonal dynamics or personally driven. Studies show that at least 5% of human factor errors in the OR are due to distractions. Lack of attention has been shown to contribute ...
Source: Current Anesthesiology Reports - September 3, 2020 Category: Anesthesiology Source Type: research

Alcohol, Tobacco, and Substance Use and Association with Opioid Use Disorder in Patients with Non-malignant and Cancer Pain: a Review
AbstractPurpose of ReviewThe following review will highlight recent studies reporting associations between alcohol and tobacco use with non-medical opioid use in the post-operative period, as well as patients with chronic non-malignant and cancer pain.Recent FindingsThe use of alcohol, tobacco, and other illegal substances are associated with an increased risk of opioid use disorder in the post-operative setting and in patients with chronic non-malignant and cancer pain.SummaryOpioid overdoses are at a national epidemic afflicting the general population. A comprehensive assessment of the risk for opioid use disorder is adv...
Source: Current Anesthesiology Reports - September 3, 2020 Category: Anesthesiology Source Type: research

Vascular Air Emboli During the Perioperative Period
AbstractPurpose of ReviewVascular air embolism is of particular concern to the anesthesiologist. The unique combination of factors encountered during procedures requiring sedation or general anesthesia increases the risk for its occurrence. Air embolism can have devastating consequences and result in morbidity and even mortality. Prevention and early diagnosis are key in mitigating the effects of this event. This manuscript provides a comprehensive review of the current knowledge and new developments in vascular air embolism.Recent FindingsOur understanding of procedures during which vascular air embolism can occur has exp...
Source: Current Anesthesiology Reports - September 2, 2020 Category: Anesthesiology Source Type: research

Airway Management in out of the Operating Room Environments
AbstractPurpose of ReviewThis review explores the expanding considerations and techniques for airway management of patients in remote settings outside of the operating room (OR). These environments bring various challenges for the patient as well as practitioner and it is essential to proceed safely.Recent FindingsNew developments in patient monitoring, oxygen delivery, and airway adjuncts have provided solutions to the many challenges involved in management of the airway in remote environments. These devices and techniques may have had their origins in the operating room but are uniquely applicable to outside locations. C...
Source: Current Anesthesiology Reports - September 2, 2020 Category: Anesthesiology Source Type: research

Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety
AbstractPurpose of ReviewWe aim to (1) identify the benefits and risks of patient-controlled analgesia and (2) analyze the risks of using various modalities of PCA among patients with traumatic injuries, sleep apnea, chronic pain, or neuropathies.Recent FindingsAn oral sufentanil PCA system may be as effective as an intravenous PCA. The overall incidence of PCA device error is less than 1%. While IV PCA may not be more effective than nurse-administered opioid among trauma patients, thoracic epidural analgesia may improve outcomes. Patients with obstructive sleep apnea or obesity are at increased risk of opioid-induced resp...
Source: Current Anesthesiology Reports - August 31, 2020 Category: Anesthesiology Source Type: research

An Update on Systemic Sclerosis and its Perioperative Management
AbstractPurpose of ReviewSystemic sclerosis or scleroderma (SSc) is a systemic, immune-mediated disease characterized by abnormal cutaneous and organ-based fibrosis that results in progressive end-organ dysfunction and decreased survival. SSc results in significant challenges for the practicing anesthesiologist due to its rarity, multi-system involvement, and limited evidence-based guidance for optimal perioperative care. In this update, we briefly discuss the recent evidence on the pathophysiology and current management of SSc, review the anesthesia-related literature, and extrapolate these observations into an optimal pe...
Source: Current Anesthesiology Reports - August 28, 2020 Category: Anesthesiology Source Type: research

Heparin Induced Thrombocytopenia for the Perioperative and Critical Care Clinician
AbstractPurpose of ReviewThis review will illustrate the importance of heparin-induced thrombocytopenia in the intraoperative and critical care settings.Recent FindingsHeparin-induced thrombocytopenia (HIT) occurs more frequently in surgical patients compared with medical patients due to the inflammatory release of platelet factor 4 and perioperative heparin exposure. Recognition of this disease requires a high index of suspicion. Diagnostic tools and therapeutic strategies have been expanded and refined in recent years.SummaryHIT is a condition where antibodies against the heparin/platelet factor 4 complex interact with p...
Source: Current Anesthesiology Reports - August 28, 2020 Category: Anesthesiology Source Type: research

Airway Leads and Airway Response Teams: Improving Delivery of Safer Airway Management?
AbstractPurpose of ReviewAirway management remains a source of significant morbidity and mortality. This review considers recent summaries of complications and looks toward strategies to improve practice using a coordinated approach.Recent FindingsA safety gap can exist between national recommendations and local practice. A lack of attention to end tidal carbon dioxide has repeatedly contributed to airway mismanagement. Clinicians must be trained in newer airway devices (videolaryngoscopes or supraglottic airways) to use them effectively. Time must be found to teach rarely performed skills (e.g., front-of-neck access). Bot...
Source: Current Anesthesiology Reports - July 19, 2020 Category: Anesthesiology Source Type: research

Perioperative Infection Transmission: the Role of the Anesthesia Provider in Infection Control and Healthcare-Associated Infections
AbstractPurpose of ReviewThis review aims to highlight key factors in the perioperative environment that contribute to transmission of infectious pathogens, leading to healthcare-associated infection. This knowledge will provide anesthesia providers the tools to optimize preventive measures, with the goal of improved patient and provider safety.Recent FindingsOver the past decade, much has been learned about the epidemiology of perioperative pathogen transmission. Patients, providers, and the environment serve as reservoirs of origin that contribute to infection development. Ongoing surveillance of pathogen transmission am...
Source: Current Anesthesiology Reports - July 16, 2020 Category: Anesthesiology Source Type: research

Perioperative Medication Error Prevention
AbstractPurpose of ReviewTo describe the incidence and types of perioperative medication errors and adverse medication events, and to provide a summary of strategies to reduce their incidence.Recent FindingsBetween 4 and 11% of perioperative medications administered may involve a medication error. Methods for detecting medication errors include incident reporting, chart review, direct observation (which is the most sensitive) and engineering modeling techniques. While a paucity of evidence exists to support recommendations to prevent medication errors, consensus recommendations involve process standardization, technology s...
Source: Current Anesthesiology Reports - July 10, 2020 Category: Anesthesiology Source Type: research

The Financial and Humanistic Costs Associated with Residual Neuromuscular Blockade
AbstractPurpose of ReviewTo review the financial and humanistic costs associated with residual neuromuscular blockade (rNMB).Recent FindingsA recent systematic review and meta-analysis of randomized controlled trials suggested that sugammadex was superior to neostigmine in producing faster and more reliable reversal of neuromuscular blockade (NMB).SummaryThe literature on clinical effectiveness of reversal agents, including time to recovery from NMB, time to tracheal extubation, incidence of postoperative residual NMB, and adverse events, indicate that sugammadex is superior to neostigmine. Cost-effectiveness including cos...
Source: Current Anesthesiology Reports - July 3, 2020 Category: Anesthesiology Source Type: research

Physician Burnout: Achieving Wellness for Providers and Patients
AbstractPurpose of ReviewThis review summarizes the history and scope of physician burnout, and explores recent advances in its understanding. With a particular focus on physicians who have completed their training, it also explores the present and future of interventions designed to alleviate the symptoms and sequelae of burnout.Recent FindingsNearly 50  years since first described, burnout continues to remain a pervasive issue within anesthesia and medicine as a whole. Recent work has continued to outline risk factors and specialty-specific prevalence, and explore individual and institutional interventions to preven...
Source: Current Anesthesiology Reports - July 2, 2020 Category: Anesthesiology Source Type: research