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

Blood Conservation in Pediatric Surgical Patients
AbstractPurpose of ReviewPatient blood management (PBM) is an encompassing term to describe strategies to promote blood conservation, reduce unnecessary transfusions, and rationalize the administration of allogeneic blood products. In this review, we will summarize strategies involved in pediatric PBM, including preoperative optimization, intraoperative blood conservation, and systematic institutional interventions.Recent FindingsPreoperative optimization of hemoglobin, along with intraoperative blood conservation strategies, can potentially reduce exposure to allogeneic blood products in pediatric surgical patients. These...
Source: Current Anesthesiology Reports - June 30, 2020 Category: Anesthesiology Source Type: research

The Multiple Casualty Scenario: Role of the Anesthesiologist
AbstractPurpose of ReviewMass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.Recent FindingsAnesthesiologists should be involved in all aspects of emergency preparedness —mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal w...
Source: Current Anesthesiology Reports - June 28, 2020 Category: Anesthesiology Source Type: research

History and Practice of Acute Normovolemic Hemodilution
AbstractPurpose for ReviewThe purpose of this review is to provide an overview of recent literature on acute normovolemic hemodilution (ANH) and conclude a consensus of beneficial effects.Recent FindingsNewfound interest in blood conservation has increased the generalizability of ANH. Overall ANH reduces transfusion rate by 20 –30% with a minimum of 650 ml whole blood (WB) removed. Greater effects have also been experienced with ≥ 1000 ml WB. With ANH, allogenic red blood cells (RBCs) and non-RBC transfusion rates are reduced intraoperatively and postoperatively. In addition, decreased length of s...
Source: Current Anesthesiology Reports - June 25, 2020 Category: Anesthesiology Source Type: research

Perioperative Bridging/Cessation of Antiplatelet Agents: 2020 Update
AbstractPurpose of ReviewPerioperative management of patients receiving antiplatelet therapy is common and must carefully balance the risk of ischemia or thrombosis with bleeding. Here we describe pathways of platelet aggregation unique to the perioperative period and mechanisms of commonly encountered antiplatelet medications, and review current literature evaluating strategies for antiplatelet management surrounding elective noncardiac and cardiac surgery.Recent FindingsAntiplatelet therapies demonstrate unique risk profiles for stent thrombosis and bleeding that may be dependent on individual genetic polymorphisms. Use ...
Source: Current Anesthesiology Reports - June 18, 2020 Category: Anesthesiology Source Type: research

Is Fresh Frozen Plasma Still Necessary for Management of Acute Traumatic Coagulopathy?
AbstractPurpose of ReviewMassive blood loss secondary to major trauma is a leading cause of death worldwide. In recent years, multiple different strategies have evolved to counteract this life-threatening condition. In this review, we will review our understanding of trauma-induced coagulopathy and summarize current clinical transfusion regimes utilized in military and civilian settings. We will review currently available blood products used to rectify the coherent disturbances of haemostasis by outlining the characteristics of the different products.Recent FindingsCurrent evidence suggests that fresh frozen plasma and fib...
Source: Current Anesthesiology Reports - June 15, 2020 Category: Anesthesiology Source Type: research

Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery
This article aims to describe the anatomical and technical aspects of various regional techniques used for fracture hip and hip surgery. We reviewed the commonly used nerve blocks, interfascial plane blocks and current evidence of their utility in hip fracture patients.Recent FindingsFascia iliaca compartment block (FICB) and femoral nerve block (FNB) are the most commonly used nerve blocks for providing pain relief for hip fracture patients. Supra-inguinal FICB has more consistent spread to all nerves and can enable better pain control. Both the FICB and FNB have shown analgesic efficacy with reduced pain scores, opioid s...
Source: Current Anesthesiology Reports - May 25, 2020 Category: Anesthesiology Source Type: research

Appropriate Use of Neuromuscular Blocking Agents and Reversal Drugs to Enhance Recovery Following Cardiac Surgery
AbstractPurpose of ReviewTo provide a brief review of the use of neuromuscular blocking agents (NMBA) in cardiac surgery, including strategies for reversal and the effects of residual blockade.Recent FindingsWhile ample evidence exists in non-cardiac surgery demonstrating the potential harms of residual neuromuscular blockade (NMB), little is known about the effect on cardiac surgery patients. Few studies have examined whether residual effects are present following cardiac surgery and whether residual NMB has an impact on postoperative outcomes. In non-cardiac surgery, the incidence of residual NMB after surgery is high an...
Source: Current Anesthesiology Reports - May 19, 2020 Category: Anesthesiology Source Type: research

Deep Neuromuscular Blockade: Does the Data Support Its Use in Surgical Patients?
AbstractPurpose of ReviewThis review aims to provide an update about the role of deep neuromuscular blockade (NMB) in surgery by providing an overview the literature of the last 3  years.Recent FindingsSince the approval of sugammadex for the reversal of deep NMB, the influence of deep NMB on facilitation of surgery as well as postoperative patient outcome has become the focus of increased interest in research. Though deep NMB is still predominantly investigated in the setting of laparoscopic surgery, some recent publications have also investigated deep block in other patient populations.SummaryDeep NMB has become inc...
Source: Current Anesthesiology Reports - May 10, 2020 Category: Anesthesiology Source Type: research

Evaluation of the Efficacy and Safety of Neostigmine in Reversing Neuromuscular Blockade
AbstractPurpose of ReviewThe minimum degree of neuromuscular recovery required before extubating the patient has progressively increased from a train-of-four ratio of 0.7 to a train-of-four ratio ≥ 0.9. The aim of the review is to evaluate the efficacy and the safety of neostigmine in antagonizing nondepolarizing neuromuscular block considering the new endpoint.Recent FindingsIncreasing evidence suggests limited efficacy of neostigmine when a TOF ratio ≥ 0.9 is considered as appropriate endpoint.SummaryThe currently accepted endpoint of adequate neuromuscular recovery challenges the efficacy of neostigm...
Source: Current Anesthesiology Reports - April 10, 2020 Category: Anesthesiology Source Type: research

Clinical Practice Guideline for the Management of Neuromuscular Blockade: What Are the Recommendations in the USA and Other Countries?
AbstractPurpose of ReviewThis review addresses various societal guidelines, standards, and consensus statements regarding optimal neuromuscular blockade management. We discuss the historical evolution of neuromuscular management as a means of identifying possible future trends.Recent FindingsWhile a recent international panel of experts has called for abandoning clinical assessment and subjective evaluation using a peripheral nerve stimulator in favor of adopting quantitative monitoring, few anesthesia societies mandate similar practices at the moment.SummaryThe current status of neuromuscular monitoring in the world is st...
Source: Current Anesthesiology Reports - April 10, 2020 Category: Anesthesiology Source Type: research

Preoperative Anemia Management: What ’s New in 2020?
AbstractPurpose of ReviewThe purpose of this article is to review the relevant evidence regarding the clinical impact of preoperative anemia, current methods of identifying anemia in the surgical population, and the current and upcoming evidence for the treatment modalities targeting preoperative anemia.Recent FindingsPreoperative anemia continues to be identified as a contributor to poor outcomes in the surgical population. Identifying anemia typically starts with hemoglobin and mean corpuscular volume. Recent laboratories have also started using iron studies with serum ferritin and transferrin saturation. Oral and IV iro...
Source: Current Anesthesiology Reports - April 7, 2020 Category: Anesthesiology Source Type: research

Detecting Residual Weakness: an Update on Quantitative Neuromuscular Monitoring
AbstractPurpose of ReviewThe purpose of this review is to summarize the newest generation of quantitative neuromuscular monitors and the different modalities that can be used to minimize the risk of postoperative residual weakness.Recent FindingsNew guidelines and consensus statements are emerging that emphasize the importance of using quantitative monitors whenever neuromuscular blocking agents (NMBAs) are administered. Additionally, there are new technologies emerging in this area.SummaryResidual neuromuscular blockade remains a common occurrence in the postoperative period. Even small degrees of residual muscle weakness...
Source: Current Anesthesiology Reports - April 3, 2020 Category: Anesthesiology Source Type: research

Local Anesthetic Systemic Toxicity (LAST) – a Review and Update
This article reviews the incidence, presentation, risk factors, and treatment for local anesthetic systemic toxicity (LAST). We have specifically focused on the changing patterns in practice, presentation, and recent updates on treatment.Recent FindingsRegional anesthesia is now an essential component of perioperative care with enhanced recovery programs, multimodal analgesia regimen, and the opioid crisis. Local anesthetics are widely used, contributing to varied presentations and increased incidence of LAST outside the operating room. Use of intravenous lipids for treatment of LAST has increased, but there is still defic...
Source: Current Anesthesiology Reports - April 3, 2020 Category: Anesthesiology Source Type: research

Sugammadex and Hypersensitivity-Related Reactions: a Review
AbstractPurpose of ReviewThe purpose of this review is to identify and understand the incidence and implications of sugammadex-induced hypersensitivity and anaphylaxis. This review also focuses on the mechanistic causation of anaphylaxis with regard to sugammadex administration and the management of anaphylaxis.Recent FindingsThe overall incidence of sugammadex-induced anaphylaxis is low, approximately 1:3500, and is comparable with other medications commonly used during the intraoperative period. Several studies and case reports have demonstrated that the mechanism of anaphylaxis is likely IgE- or basophil-mediated and th...
Source: Current Anesthesiology Reports - March 31, 2020 Category: Anesthesiology Source Type: research

Regional Anesthesia in the Burn Trauma Patient
AbstractPurpose of ReviewThis review will highlight early use of regional anesthesia for facilitating analgesia as both an adjunct and primary role in perioperative care of burned patients.Recent FindingsBurn patients are at risk of serious long-term medical and psychiatric consequences related to untreated pain. There is growing evidence that regional anesthesia is an acceptable and important modality in burn patients.SummaryRegional anesthesia provides many benefits, including a reduction in sedating medications and a model for improved productivity. There is limited data on the use of regional anesthesia for burn patien...
Source: Current Anesthesiology Reports - March 30, 2020 Category: Anesthesiology Source Type: research

Incidence and Risk Factors for Postoperative Residual Neuromuscular Blockade
AbstractPurpose of ReviewTo define the incidence of residual neuromuscular blockade (rNMB) and identify patients at risk.Recent FindingsIncidence of rNMB continues to be high, and risk factors are complex and difficult to predict. Sequelae of rNMB, however, are significant.SummaryDespite literature describing the significance of rNMB on patient safety, the incidence continues to be high, and risk factors are difficult to predict. Patient, anesthetic, and surgical risk factors all contribute, and an understanding of the unique risks for each individual patient is required to properly prevent rNMB. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - March 30, 2020 Category: Anesthesiology Source Type: research

Residual Neuromuscular Blockade and Postoperative Pulmonary Complications: What Does the Recent Evidence Demonstrate?
AbstractPurpose of ReviewThe purpose of this review is to assess how residual neuromuscular block impacts postoperative pulmonary complications and whether we can modify the risk by improving certain aspects in daily clinical care.Recent findingsPostoperative respiratory impairment may be due to various causes, such as age, surgery type, comorbidity, smoking, preoperative anemia, and general anesthesia. However, increasing evidence suggests that residual neuromuscular block is an important risk factor for postoperative pulmonary complications and may affect the outcome. Conflicting data from some recent reports show that t...
Source: Current Anesthesiology Reports - March 26, 2020 Category: Anesthesiology Source Type: research

Training for Trauma Anesthesia: Role of Education and Simulation-Based Training
This article will review different strategies to teach these complex skills with an emphasis on simulation-based training.Recent FindingsIn addition to traditional educational formats such as didactic sessions, simulation-based education can provide unique opportunities for teaching technical skills and non-technical skills. Each type of skill can be integrated into immersive high-fidelity simulation to train both the individual and the team in the care of trauma patients. Both original and review studies provide evidence that simulation can improve technical and cognitive skills of the individual anesthesia provider as we...
Source: Current Anesthesiology Reports - March 26, 2020 Category: Anesthesiology Source Type: research

Blood Conservation for Complex Spine and Intracranial Procedures
AbstractPurpose of ReviewNeurological surgery, which includes intracranial and spine surgery, is associated with a significant risk of major perioperative bleeding. This review highlights the various blood conservation techniques currently in practice for major, complex spine and intracranial surgery.Recent FindingsSeveral techniques have been described to reduce blood loss and transfusion requirements perioperatively. These include preoperative risk identification and stratification and use of different blood conservation strategies perioperatively. The efficacy and safety of tranexamic acid has been demonstrated in major...
Source: Current Anesthesiology Reports - March 22, 2020 Category: Anesthesiology Source Type: research

Patient Blood Management in Adult Extracorporeal Membrane Oxygenation Patients
AbstractPurpose of ReviewThis narrative review provides a framework for contemporary patient blood management (PBM) in adult extracorporeal membrane oxygenation (ECMO) patients.Recent FindingsECMO use is growing in adults with cardiopulmonary failure and bleeding, and allogeneic transfusion is common. There are no high quality randomized controlled trials to guide transfusion strategies or anticoagulation. Recent studies offer some insight into the coagulation changes that occur during ECMO, optimal anticoagulation practices, and potential therapies for bleeding.SummaryPBM for adult ECMO patients should be grounded in an u...
Source: Current Anesthesiology Reports - March 19, 2020 Category: Anesthesiology Source Type: research

Factor Concentrate-Based Approaches to Blood Conservation in Cardiac Surgery: European Perspectives in 2020
AbstractPurpose of ReviewRecent European guidelines and expert consensus statements recommend the use of coagulation factor concentrates to improve hemostasis in bleeding patients after cardiac surgery and for patient blood management. This review summarizes the current evidence relating to coagulation management with the help of coagulation factor concentrates as supported by many European experts and institutes.Recent FindingsMaintaining a postoperative fibrinogen level>  1.5–2 g/l by administering fibrinogen concentrate in hypofibrinogenemic bleeding patients has been suggested. Likewise, the use of...
Source: Current Anesthesiology Reports - March 17, 2020 Category: Anesthesiology Source Type: research

Preoperative Evaluation for Lung Resection Surgery
AbstractPurpose of ReviewThe purpose of this article is to review the literature surrounding preoperative assessment and management of patients undergoing lung resection surgery.Recent FindingsThe traditional preoperative cardiovascular risk assessment can be further refined in patients undergoing lung resection surgery with the Thoracic Revised Cardiac Risk Index and cardiac biomarkers such as B-type natriuretic peptide. Cardiorespiratory exercise testing parameters such as the maximal achieved oxygen consumption (VO2 peak) and the minute ventilation to carbon dioxide output (VE/VCO2) slope are strong preoperative prognos...
Source: Current Anesthesiology Reports - March 16, 2020 Category: Anesthesiology Source Type: research

Anesthetic Challenges in Treating the Older Adult Trauma Patient: an Update
AbstractPurpose of ReviewTo highlight challenges specific to anesthesia and perioperative care of injured older adults and present novel modalities to improve outcomes in this vulnerable population.Recent FindingsWe will describe some of the current directions available for anesthesiologists to improve outcomes in the elderly surgical population: interventions to ameliorate perioperative neurocognitive disorders, reversal of treatment with anti-coagulant medications, controversies in pain management, and increasing utilization of regional anesthesia techniques. Finally, frailty assessment and comprehensive geriatric care a...
Source: Current Anesthesiology Reports - March 13, 2020 Category: Anesthesiology Source Type: research

Management of Neuromuscular Blockade in the Elderly and Morbidly Obese Patient: What Does the Data Show?
AbstractPurpose of ReviewThis review addresses considerations for optimal neuromuscular blockade management in the elderly and obese. The evidence for adjusting dosing for common neuromuscular blocking drugs (NMBDs) and their antagonists are discussed.Recent FindingsIn the elderly patient, aminosteroidal NMBDs have a slower onset and prolonged duration of action. Aging has minimal effects on the organ-independent metabolism of the benzylisoquinolinium NMBDs. Slower circulatory times and reduced renal function in the elderly also have implications on the clinical effects of NMBD antagonists. Since drug clearance and distrib...
Source: Current Anesthesiology Reports - March 5, 2020 Category: Anesthesiology Source Type: research

Recommendations for Preoperative Assessment and Shared Decision-Making in Cardiac Surgery
AbstractPurpose of ReviewRecommendations about shared decision-making and guidelines on preoperative evaluation of patients undergoing non-cardiac surgery are abundant, but respective recommendations for cardiac surgery are sparse. We provide an overview of available evidence.Recent FindingsWhile there is currently no consensus statement on the preoperative anesthetic evaluation and shared decision-making for the adult patient undergoing cardiac surgery, evidence pertaining to specific organ systems is available.SummaryWe provide a comprehensive review of available evidence pertaining to preoperative assessment and shared ...
Source: Current Anesthesiology Reports - March 3, 2020 Category: Anesthesiology Source Type: research

Cardiopulmonary Exercise Testing for Preoperative Evaluation: What Does the Future Hold?
AbstractPurpose of ReviewCardiopulmonary exercise testing(CPET) informs the preoperative evaluation process by providing individualised risk profiles; guiding shared decision-making, comorbidity optimisation and preoperative exercise training; and informing perioperative patient management. This review summarises evidence on the role of CPET in preoperative evaluation and explores the role of novel and emerging CPET variables and alternative testing protocols that may improve the precision of preoperative evaluation in the future.Recent FindingsCPET provides a wealth of physiological data, and to date, much of this is unde...
Source: Current Anesthesiology Reports - February 2, 2020 Category: Anesthesiology Source Type: research

Enhanced Recovery After Surgery
AbstractPurpose of ReviewTo provide a brief summary of the progress of enhanced recovery over the last 5 to 10  years and set out what the future might hold for such programmes.Recent FindingsThere has been significant progress in the adoption of enhanced recovery programmes across multiple surgical specialities. However there is still difficulty in sustaining a target of>  80% compliance, which has been identified through research as the optimal level to observe best patient results. With increasing interest in perioperative medicine and prehabilitation, more focus is being put into enhanced recovery progra...
Source: Current Anesthesiology Reports - January 26, 2020 Category: Anesthesiology Source Type: research

Preprocedural Assessment for Patients Anticipating Sedation
AbstractPurpose of ReviewThe purpose of this review is to provide a summary of the recent literature addressing the aims, content, outcomes and quality metrics for presedation evaluation.Recent FindingsThere is a trend towards multidisciplinary development of minimum standards for sedation practice, including presedation assessment. A risk-based paradigm underpins presedation assessment. Improved and validated risk scores are required, especially to predict airway difficulty. There is an increasing focus on skillsets rather than roles. Clinicians should explain the intended depth of sedation, how that may be experienced by...
Source: Current Anesthesiology Reports - January 23, 2020 Category: Anesthesiology Source Type: research

Preoperative Assessment for Inpatients
AbstractPurpose of the ReviewThis chapter will highlight several important concepts that are relevant to the assessment and optimization of hospitalized patients prior to the administration of an anesthetic.Recent FindingsPatients admitted to hospital comprise a unique population. The risk-benefit ratio of pre-procedural investigations and the economic implications of specific management strategies may be significantly different than for patients managed on an ambulatory basis. The anesthesiologist must have a thorough understanding of these factors. Preoperative workflows provide effective coordination of the necessary re...
Source: Current Anesthesiology Reports - January 16, 2020 Category: Anesthesiology Source Type: research