Delirium in Intensive Care
AbstractPurpose of ReviewDelirium in the intensive care unit (ICU) has become increasingly acknowledged as a significant problem for critically ill patients affecting both the actual course of illness as well as outcomes. In this review, we focus on the current evidence and the gaps in knowledge.Recent FindingsThis review highlights several areas in which the evidence is weak and further research is needed in both pharmacological and non-pharmacological treatment. A better understanding of subtypes and their different response to therapy is needed and further studies in aetiology are warranted. Larger studies are needed to...
Source: Current Anesthesiology Reports - September 3, 2021 Category: Anesthesiology Source Type: research

What ’s New in Neuraxial Labor Analgesia
This article provides an update of recent practice trends in neuraxial labor analgesia. It reviews available evidence regarding management of labor pain in obstetric patients with COVID-19, serious adverse events in obstetric anesthesia to help inform risk/benefit decisions, and increasingly popular neuraxial labor analgesia techniques and adjuvants. State-of-the-art modes of epidural drug delivery are also discussed.Recent FindingsThere has recently been a focus on several considerations specific to obstetric anesthesia, such as anesthetic management of obstetric patients with COVID-19, platelet thresholds for the safe pe...
Source: Current Anesthesiology Reports - August 27, 2021 Category: Anesthesiology Source Type: research

Patient Blood Management in Pediatric Anesthesiology
This study reviews important evidence regarding PMB strategies in pediatric patients. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - August 26, 2021 Category: Anesthesiology Source Type: research

Enhanced Recovery After Neurosurgery
AbstractPurpose of ReviewEnhanced Recovery After Surgery (ERAS) protocols have shown significant success in improving pain scores and postoperative recovery and reducing hospital length of stay. Since the initial application in the colorectal patient population in the late 1990s, ERAS pathways have expanded to include many surgical subspecialties. This review explores the applicability of ERAS and its components in the field of cranial and spinal surgery.Recent FindingsOnly recently have researchers begun to study how to apply ERAS principles to intracranial or spine procedures. To date, robust evidence is lacking. Spine s...
Source: Current Anesthesiology Reports - August 20, 2021 Category: Anesthesiology Source Type: research

Update on Non-neuraxial Labor Analgesia
AbstractPurpose of ReviewThis review will present recent updates for the use of non-neuraxial analgesia for laboring women.Recent FindingsNon-neuraxial labor analgesia by nitrous oxide and intravenous opioids are described, and safety concerns with regard to remifentanil administration have been a major focus of recent studies. Fentanyl and nitrous oxide offer some efficacy, albeit less than remifentanil, however with a greater safety margin.SummaryWomen may request or require alternatives to neuraxial labor analgesia, in some cases due to concurrent comorbidities. Remifentanil offers the most efficacious alternative analg...
Source: Current Anesthesiology Reports - August 18, 2021 Category: Anesthesiology Source Type: research

Anesthesia for the Pediatric Patient With Epilepsy and Minimally Invasive Surgery for Epilepsy
AbstractPurpose of ReviewThis review outlines a perioperative approach to the pediatric patient with a seizure disorder and anesthesia for minimally invasive epilepsy surgical treatment.Recent FindingsSurgical interventions for epilepsy have undergone dramatic progression. Minimally invasive treatments and high-tech imaging, such as intraoperative magnetic resonance imaging (iMRI), are recent advances. Many anesthetics have epileptogenic activity and must be adjusted for an effective anesthetic. The needs for imaging techniques, moving patients in and out of computer tomography (CT) and magnetic resonance imaging (MRI) loc...
Source: Current Anesthesiology Reports - August 16, 2021 Category: Anesthesiology Source Type: research

Application of Continuous Positive Airway Pressure During Video-Assisted Thoracoscopic Surgery
AbstractPurpose of ReviewVideo-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are used for anatomic resection of early stage cancer. These surgical techniques require the use of one-lung ventilation (OLV). During OLV, an obligatory intrapulmonary shunt may produce hypoxemia. One method to correct hypoxemia is with the use of continuous positive airway pressure (CPAP). This review focuses on 1) the lung physiology of OLV; 2) application of CPAP in VATS or RATS during supine and lateral position; and 3) the application of CPAP in COVID-19 patients during OLV.Recent FindingsStudies hav...
Source: Current Anesthesiology Reports - August 10, 2021 Category: Anesthesiology Source Type: research

The Use of Corticosteroids for Cardiopulmonary Bypass in Adults
AbstractPurpose of ReviewCardiopulmonary bypass for on-pump cardiac surgery induces a systemic inflammation that may contribute to postoperative major complications. To reduce this inflammatory response in patients undergoing heart surgery, the perioperative use of anti-inflammatory corticosteroids has long been recommended to improve clinical outcomes. However, the efficacy and safety of steroids remain still unclear.Recent FindingsWe reviewed recent published literature, including the large clinical trials DECS and SIRS and the two meta-analysis by Dvirnik et al. (2018) and Ng et al. (2020), on mortality and major postop...
Source: Current Anesthesiology Reports - August 10, 2021 Category: Anesthesiology Source Type: research

An Examination of History for Promoting Diversity in Neuroscience
AbstractPurpose of ReviewA review of American history is presented to understand how public policy has contributed to a disproportionate burden of disease in members of underrepresented groups. A review of research conducted in theStroke Belt provides an opportunity to examine more closely traditional and non-traditional risk factors in an effort to consider strategies for change.Recent FindingsA diverse physician workforce has been offered as a way of improving care for our increasingly diverse populace. Given the expected increased prevalence of stroke in communities of color and the impact of stress from discrimination ...
Source: Current Anesthesiology Reports - August 9, 2021 Category: Anesthesiology Source Type: research

Aortic Valve Neocuspidization Using Autologous Pericardium (Ozaki Procedure): an Alternative to Aortic Valve Replacement in Adult Cardiac Surgery?
AbstractPurpose of the ReviewThe aim of this article is to describe the technique of aortic valve neocuspidization using autologous pericardium (AVNeo, “OZAKI procedure”) in adult cardiac surgery, to analyze recent findings, and to discuss benefits and limitations of this technique.Recent FindingsPotential benefits of this technique include excellent hemodynamic performances, minimal use of foreign material, low rates of permanent pacemaker implantation, and omission of oral anticoagulation. However, data regarding the durability of the procedure are hitherto limited, and the procedure is associated with a high...
Source: Current Anesthesiology Reports - August 6, 2021 Category: Anesthesiology Source Type: research

Pediatric Regional Anesthesia: New Techniques, Better Outcomes?
AbstractPurpose of ReviewThe following discussion aims to provide a review of current trends in the subspeciality of pediatric regional anesthesia, highlighting recent evidence-based literature, especially with respect to improved outcomes with newer techniques.Recent FindingsMuch of the recent literature focuses on novel truncal blocks and alternate approaches to regional anesthesia for urologic surgery. In many cases, these newer techniques have been shown to improve postoperative pain scores and lower rescue analgesic requirements.SummaryCurrent trends in pediatric regional anesthesia are focused on providing innovative...
Source: Current Anesthesiology Reports - July 31, 2021 Category: Anesthesiology Source Type: research

Special Anesthesiologic Considerations in Robot-Assisted Thoracic Surgery
AbstractPurpose of ReviewThis review summarizes the key issues for preoperative, peri- and intraoperative, and postoperative patient management for robotic-assisted thoracic surgery (RATS). It provides practical guidance for anesthesiologists and thoracic surgeons starting a RATS program.Recent FindingsRATS is a new technological approach to execute minimal invasive chest operations. In management of RATS patients, the established ERAS principles for video-assisted thoracoscopic surgery (VATS) apply. In addition, RATS imposes additional conditions on anesthesiologists, nurses, and surgeons alike: The spatial constriction i...
Source: Current Anesthesiology Reports - July 28, 2021 Category: Anesthesiology Source Type: research

Pain Management in Children During the COVID-19 Pandemic
AbstractPurpose of ReviewFor many children, the SARS-CoV-2 pandemic has impacted the experience and treatment of their pain. This narrative review draws from the pain literature and emerging findings from COVID-19 research to highlight potentially meaningful directions for clinical consideration and empirical inquiry in the months and years to come.Recent FindingsCOVID-19 has been linked to diffuse acute pains as well as chronic pain sequelae. Contextual factors known to increase vulnerability for pain and associated functional disability have been exacerbated during the pandemic. Beyond these salient concerns has been the...
Source: Current Anesthesiology Reports - July 26, 2021 Category: Anesthesiology Source Type: research

Role of Echocardiography for the Perioperative Assessment of the Right Ventricle
AbstractPurpose of ReviewThis review aims to highlight the perioperative echocardiographic evaluation of right ventricular (RV) function with strengths and limitations of commonly used and evolving techniques. It explains the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and describes the perioperative changes of RV function echocardiographers should be aware of.Recent FindingsRV dysfunction is an entity with strong influence on outcome. However, its definition and assessment in the perioperative interval are not well-defined. Moreover, values assessed by TTE and TEE are not inter...
Source: Current Anesthesiology Reports - July 26, 2021 Category: Anesthesiology Source Type: research

Pediatric Airway Management in Times of COVID-19 —a Review of the Evidence and Controversies
AbstractPurpose of ReviewThis review summarizes and provides a comprehensive narrative synthesis of the current evidence on pediatric airway management during the COVID-19 pandemic.Recent FindingsThe safe care of children undergoing airway management is a primary concern for pediatric anesthesiologists. The COVID-19 pandemic has brought challenges related to airway management and the use of personal protective equipment, aerosol barriers, and the need for simulation and intubation teams. The risk of COVID-19 transmission to the health care worker may be lower in children due to the smaller volume of aerosol dispersal. The ...
Source: Current Anesthesiology Reports - July 24, 2021 Category: Anesthesiology Source Type: research

Ketamine in Modern Neuroanesthesia Practice
AbstractPurpose of ReviewKetamine has a number of clinical uses and properties that suggest a role for the drug in neuroanestheisa practice. “Dogma” and “myths” persist with regard to its effects on cerebral hemodynamics and intracranial pressure which have limited its use in Neuroanesthesia and care of the critically ill brain-injured patient. This review aims to educate the clinician on the possible role of ketamine in modern n euroanesthesia practice.Recent FindingsA number of systemic reviews support the use of ketamine in patients with acute brain injury and raised intracranial pressure (ICP). ...
Source: Current Anesthesiology Reports - July 19, 2021 Category: Anesthesiology Source Type: research

“Pick Up a Knife, Save a Life”: Emergency Front-of-Neck Airway for the Non-Surgeon Clinician
AbstractPurpose of ReviewProficiency obtaining an emergency front-of-neck airway (eFONA) is a requirement of all advanced airway managers. The aim of this review is to discuss a single, ideal eFONA technique for non-surgeon clinicians faced with “can’t ventilate, can’t oxygenate” (CVCO) scenarios. We intend to identify potential pitfalls of the suggested technique and to provide practical strategies to optimize procedure success in crisis.Recent FindingsIdentification of the cricothyroid membrane via solely external palpation has been shown to be unreliable, particularly in the obese and in females ...
Source: Current Anesthesiology Reports - July 17, 2021 Category: Anesthesiology Source Type: research

Obesity, Race, and Perioperative Complications
AbstractPurpose of ReviewThis review highlights the perioperative issues pediatric anesthesiologists may encounter while caring for an increasingly obese and racially/ethnically diverse patient population. We provide insight into the scope and impact of both pediatric obesity and pediatric minority status on perioperative management and outcomes and emphasize their points of intersection.Recent FindingsIn recent decades, obesity prevalence in children has steadily increased and the age at onset has declined. Obesity confers significant perioperative risk in pediatric patients and has strong associations with additional com...
Source: Current Anesthesiology Reports - July 17, 2021 Category: Anesthesiology Source Type: research

The Anesthetic Management of Patients Undergoing Nonintubated Video-Assisted Thoracic Surgery
AbstractPurpose of ReviewThis review focuses on describing the procedural and anesthetic management of patients undergoing nonintubated video-assisted thoracoscopy surgery.Recent FindingsMost thoracic surgery is performed under general endotracheal anesthesia with either a double lumen endotracheal tube or a bronchial blocker. In an attempt to lessen the incidence and severity of postoperative complications, the nonintubated video-assisted thoracoscopic technique was developed, where the surgical procedure is performed under regional anesthesia with sedation. Currently, this technique is recommended for the elderly and in ...
Source: Current Anesthesiology Reports - July 16, 2021 Category: Anesthesiology Source Type: research

State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients
AbstractPurpose of ReviewThis review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology ’s (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics.Recent FindingsResearchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the us...
Source: Current Anesthesiology Reports - July 14, 2021 Category: Anesthesiology Source Type: research

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic
AbstractPurpose of ReviewThis review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures.Recent FindingsA significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating p...
Source: Current Anesthesiology Reports - July 13, 2021 Category: Anesthesiology Source Type: research

Volatile Versus Intravenous Anesthetics in Cardiac Anesthesia: a Narrative Review
AbstractPurpose of the ReviewThe present review addresses clinicians and gives an overview about the experimental rationale for pharmacological conditioning associated with volatile anesthetics, opioids, and propofol; the current clinical data; and the technical considerations regarding the clinical routine in cardiac anesthesia.Recent FindingsVolatile anesthetics have been standard of care for general anesthesia for cardiac surgery, especially while using cardiopulmonary bypass. The 2019 published MYRIAD trial was not able to show a difference in mortality or cardiac biomarkers for volatile anesthetics compared to total i...
Source: Current Anesthesiology Reports - July 10, 2021 Category: Anesthesiology Source Type: research

Hypoxemia During One-Lung Ventilation: Does It Really Matter?
AbstractPurpose of ReviewHypoxemia during one-lung ventilation, while decreasing in frequency, persists as an intraoperative challenge for anesthesiologists. Discerning when desaturation and resultant hypoxemia correlates to tissue hypoxia is challenging in the perioperative setting and requires a thorough understanding of the physiology of oxygen delivery and tissue utilization.Recent FindingsOxygen delivery is not directly correlated with peripheral oxygen saturation in patients undergoing one-lung ventilation, emphasizing the importance of hemoglobin concentration and cardiac output in avoiding tissue hypoxia. While hea...
Source: Current Anesthesiology Reports - July 7, 2021 Category: Anesthesiology Source Type: research

Electroencephalogram Monitoring in Anesthesia Practice
AbstractPurpose of ReviewWe review the basic neurophysiological foundations of the adult electroencephalographic signal and how to apply the EEG to the modern anesthetic clinical practice, the different anesthetic drugs signatures, and their neurobiological background. We finally discuss how the intraoperative use of the EEG may be implemented eventually to improve short- and long-term outcomes.Recent FindingsWith the growing knowledge of the electroencephalographic signatures of anesthetic drugs, perioperative EEG monitoring constitutes an important tool to titrate the dose of hypnotic drugs avoiding over- and underdosing...
Source: Current Anesthesiology Reports - July 5, 2021 Category: Anesthesiology Source Type: research

Anesthetic Considerations and Complications of Cleft Palate Repairs. What ’s New?
AbstractPurpose of ReviewThis review illustrates the latest considerations and complications of cleft palate (CP) repair. Cleft lip and palate are the most common craniofacial deformities; their repair is a routine surgery performed early in life. Potential complications might be of severe complexity, and the anesthesiologist must be familiar with them.Recent FindingsThe awareness of neurotoxicity related to anesthesia has grown. Currently, there is no evidence supporting the postponement of CP surgery; early repair is important to ensure the best development of the child. From the pain point of view, the use of dexmedetom...
Source: Current Anesthesiology Reports - July 1, 2021 Category: Anesthesiology Source Type: research

Trauma-Induced Coagulopathy: Diagnosis and Management in 2020
AbstractPurpose of ReviewThis review describes the mechanisms underlying trauma-induced coagulopathy (TIC) and the current strategies to measure and mitigate the negative effects of TIC during the initial stages of trauma resuscitation and care.Recent FindingsTrauma patients can manifest both early hypocoagulable and later hypercoagulable phenotypes. These are not fixed states and patient transition between states postinjury. Recent trends in resuscitation, driven by the military experience, have promoted the return to whole blood as the initial resuscitative fluid in the severely injured patient, but goal-directed blood p...
Source: Current Anesthesiology Reports - July 1, 2021 Category: Anesthesiology Source Type: research

Enhanced Recovery After Cardiac Surgery: Where Do We Stand?
AbstractPurpose of ReviewEnhanced recovery after surgery (ERAS) protocols are multimodal and multi-professional strategies to enhance postoperative convalescence and thereby reduce the length of hospital stay and hospital-associated complications. This review provides an up-to-date overview about basic principles of enhanced recovery after surgery protocols, their transfer into cardiac surgery, and their current state of evidence. It is supposed to offer clinical implications for further adaptations and implementations of such protocols in cardiac surgery.Recent FindingsERAS protocols are a story of success in numerous sur...
Source: Current Anesthesiology Reports - June 29, 2021 Category: Anesthesiology Source Type: research

Ultrasound Imaging of the Spine for Central Neuraxial Blockade: a Technical Description and Evidence Update
This article describes the anatomy of the spine, relevant ultrasonographic views, and the techniques used to perform the neuraxial blocks using ultrasound imaging. Finally, we review the available evidence for the use of ultrasound imaging to perform neuraxial blocks.Recent FindingsCentral neuraxial blockade using traditional landmark palpation is a reliable technique to provide surgical anesthesia and postoperative analgesia. However, factors like obesity, spinal deformity, and previous spine surgery can make the procedure challenging. The use of ultrasound imaging has been shown to assist in these scenarios.SummaryPrepro...
Source: Current Anesthesiology Reports - June 26, 2021 Category: Anesthesiology Source Type: research

Anesthesia Considerations for Transcatheter Mitral and Aortic Valve Procedures
AbstractPurpose of ReviewThis review considers the anesthetic management for patients undergoing transcatheter mitral valve replacement and repair (TMVR and TMVRep) and transcatheter aortic valve replacement (TAVR). Clinical indications and preoperative considerations will be discussed before exploring intraoperative anesthetic management and potential complications. To conclude, the echocardiographic assessment for each procedure will be reviewed.Recent FindingsAdvancements in transcatheter techniques have made it a viable option for patients who are poor surgical candidates. As a result, anesthetic management, including ...
Source: Current Anesthesiology Reports - June 17, 2021 Category: Anesthesiology Source Type: research

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