Direct Admission to the Operating Room for Severe Trauma
AbstractPurpose of ReviewThis review presents the historical and current evolvement of direct to operating room (DTOR) along with evidence from various trauma centers, both civilian and military. It aims to provide guidance on identifying patients for whom bypassing the emergency department (ED) and proceeding DTOR would be advantageous for survival and reducing morbidity.Recent FindingsRecent studies have suggested that simply bypassing the ED with patients requiring surgical intervention shortens the time to definitive resuscitation and bleeding control, in addition to reducing mortality. DTOR protocols are evolving with...
Source: Current Anesthesiology Reports - January 26, 2022 Category: Anesthesiology Source Type: research

Thrombin Generation in Trauma Patients: How Do we Navigate Through Scylla and Charybdis?
AbstractPurpose of Review Coagulopathy is a complex pathological condition manifested through the insufficient or excessive tendency to form blood thrombi, which can be caused by trauma and surgery. A promising strategy to mitigate coagulopathy is the balanced restoration of the generation of thrombin — the main enzyme in the blood-coagulation system. We review studies focusing on thrombin, traumatic coagulopathy, and hemostatic balance — a concept aimed to avoid abnormally weak or excessively strong coagulation responses.Recent FindingsThrombin generation is impacted by coagulopathic conditions described by ...
Source: Current Anesthesiology Reports - January 24, 2022 Category: Anesthesiology Source Type: research

Nutrition Status Optimization for Improved Perioperative Outcomes
AbstractPurpose of ReviewPreoperative malnutrition is common in surgical patients and occurs in up to two-in-three major gastrointestinal and cancer surgery patients. Perioperative malnutrition is well-known to be associated with adverse clinical outcomes following major surgery. Yet, malnutrition is seldom screened for before surgery worldwide. This worldwide “silent epidemic” of perioperative malnutrition could easily be addressed as part of routine preoperative optimization. This review addresses the critical role of nutrition therapy in perioperative optimization to improve surgical outcomes. It describes r...
Source: Current Anesthesiology Reports - January 22, 2022 Category: Anesthesiology Source Type: research

Point-of-Care Ultrasound for the Trauma Anesthesiologist
AbstractPurpose of ReviewWith advances in technology and availability of handheld ultrasound probes, studies are focusing on the perioperative care of patients, but a limited number specifically on trauma patients. This review highlights recent findings from studies using point of care ultrasound (POCUS) to improve the care of trauma patients.Recent FindingsMajor findings include the use of POCUS to assess volume status of trauma patients upon arrival to measure the major vasculature. Additionally, several studies have advanced the use of POCUS to identify pneumothorax in trauma patients. Finally, the ASA POCUS certificati...
Source: Current Anesthesiology Reports - January 20, 2022 Category: Anesthesiology Source Type: research

Hematinic and Iron Optimization in Peri-operative Anemia and Iron Deficiency
This article explores the current understanding of perioperative anemia and iron deficiency with reference to definition, diagnosis, and treatment.Recent FindingsIron deficiency is the most common cause of anemia. It can arise from reduced iron intake, poor absorption, or excess iron loss. Inflammation throughout the preoperative period can drive iron sequestration, leading to a functional deficiency of iron and the development of what was referred to until recently as the “anemia of chronic disease.” Current best practice guidance supports the routine administration of preoperative intravenous iron to treat an...
Source: Current Anesthesiology Reports - January 19, 2022 Category: Anesthesiology Source Type: research

Trauma and the Anesthesiologist: an International Perspective
AbstractPurpose of ReviewThis review highlights the roles and responsibilities of anesthesiologists in the management of critically ill trauma patients in different countries around the world. It provides a summary of the scope of practice of different branches of anesthesiology that are involved in the resuscitation of trauma patients.Recent FindingsThe reduced indication for operative intervention in trauma along with the increasing role for anesthesia in managing trauma patients outside the operating room has created a demand for trauma acute care anesthesiologists. The leading obstacle to more prevalent offsite trauma ...
Source: Current Anesthesiology Reports - January 19, 2022 Category: Anesthesiology Source Type: research

Perioperative Guidelines on Antiplatelet and Anticoagulant Agents: 2022 Update
AbstractPurpose of ReviewMultiple guidelines and recommendations have been written to address the perioperative management of antiplatelet and anticoagulant drugs. In this review, we evaluated the recent guidelines in non-cardiac, cardiac, and regional anesthesia. Furthermore, we focused on unresolved problems and novel approaches for optimized perioperative management.Recent FindingsVitamin K antagonists should be stopped 3 to 5 days before surgery. Preoperative laboratory testing is recommended. Bridging therapy does not decrease the perioperative thromboembolic risk and might increase perioperative bleeding risk. In pat...
Source: Current Anesthesiology Reports - January 19, 2022 Category: Anesthesiology Source Type: research

The Use of Whole Blood Transfusion in Trauma
AbstractPurpose of ReviewThis review illustrates the current benefits, limitations, ongoing research, and future paths for Low Titer O Whole Blood compared to Component Therapy in massive transfusion for trauma patients.Recent FindingsMany studies show that compared to Component Therapy, Low Titer O Whole Blood transfusion is associated with better patient outcomes and simplified transfusion logistics among others. There are, however, issues with cost, supply/demand and handling of Whole Blood that limit its use, but experience in the military setting has shown that these limitations can be easily overcome.SummaryThe use o...
Source: Current Anesthesiology Reports - January 17, 2022 Category: Anesthesiology Source Type: research

Recommendations for Mechanical Ventilation During General Anesthesia for Trauma Surgery
AbstractPurpose of ReviewMechanical ventilation is an essential part of anesthesia for trauma surgery, but there are few recommendations for intraoperative ventilator management. This review examines the limited evidence for intraoperative ventilator practices during trauma surgeryRecent FindingsMost recommendations for surgical ventilator management are derived from ICU guidelines, but trauma surgery includes considerations not always present in the ICU. During trauma surgery, normoxia or mild hypoxia should be maintained. Permissive hypercapnia may be beneficial in the absence of metabolic acidosis, but priority should b...
Source: Current Anesthesiology Reports - January 15, 2022 Category: Anesthesiology Source Type: research

Considerations for the Older Trauma Patient
AbstractPurpose of ReviewThe number of older adults suffering major trauma has increased dramatically. This review provides an update on significant areas of research undertaken in recent years to improve care of this complex and challenging patient group.Recent Findings.Rates of undertriage remain high in geriatric trauma with detrimental impact on patient outcomes. Current pre-hospital and hospital-based triage systems require modification. Co-management of patients with specialist geriatric teams can improve clinical outcome but the best model of care and method of implementation is deliberated. Frailty is perhaps more ...
Source: Current Anesthesiology Reports - January 14, 2022 Category: Anesthesiology Source Type: research

Is the Integration of Prehabilitation into Routine Clinical Practice Financially Viable? A Financial Projection Analysis
This article extends previous research-based economic analyses with financial projections of the costs, cost-savings, and cost-benefit of clinical prehabilitation. To accomplish this, we used (i) projected prehabilitation program costs; (ii) surgical morbidity rates based on data from the American College of Surgeons, National Surgical Quality Improvement Program (NSQIP); (iii) the median cost of surgical morbidity; and (iv) the projected reduction in surgical morbidity by prehabilitation.Recent FindingsUsing the best available evidence for our calculation parameters, we project a net positive cost-benefit of clinically in...
Source: Current Anesthesiology Reports - January 10, 2022 Category: Anesthesiology Source Type: research

The Use of Tranexamic Acid in Trauma
This study reviews the role of TXA in trauma patients and the potential risks and benefits TXA administration may have in this patient population. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - January 6, 2022 Category: Anesthesiology Source Type: research

Anesthetic Considerations for the Trauma Patient with Obesity
This article aims to review the specific challenges anesthesiologists may face when caring for trauma patients with obesity and provide current anesthetic strategies to treat injuries and reduce complications.Recent FindingsThe concept of the cushion effect and obesity paradox is controversial. While some studies state that obesity may be protective in the setting of penetrating or blunt trauma, other studies find that obesity increases the risk of complications, perhaps due to the increased incidence of associated comorbidities in this population.SummaryTrauma is one of the leading causes of death worldwide. As the preval...
Source: Current Anesthesiology Reports - January 4, 2022 Category: Anesthesiology Source Type: research

Care of the Patient with Epidermolysis Bullosa
AbstractPurpose of ReviewThis review highlights advances in care of patients with severe epidermolysis bullosa (EB) that impact the anesthesiologist. Topics covered include EB molecular genetics, preoperative assessment, intra- and postoperative anesthetic care. Related topics include advances in common procedures performed on EB patients and new clinical practice guidelines.Recent FindingsThe latest EB nomenclature has largely eliminated eponyms. Molecular classification has revealed direct links to cardiomyopathy in several subtypes. Other molecular/genetic links to phenotypic associations such as muscular dystrophy and ...
Source: Current Anesthesiology Reports - January 4, 2022 Category: Anesthesiology Source Type: research

Anesthesia for Long QT Syndrome
AbstractPurpose of ReviewThis review article seeks to discuss the salient information about the known genetic variants associated with congenital long QT syndrome (LQTS) and describe the current anesthetic considerations.Recent FindingsLQTS describes a heterogeneous group of patients with varying genetic mutations that cause an increased risk of torsade de pointe and sudden death. Research continues to identify more genetic mutations associated with LQTS subtypes. Publications of clinical experience with LQTS patients under general anesthesia provide new insights on the risk of medication inducing arrhythmias in these pati...
Source: Current Anesthesiology Reports - December 1, 2021 Category: Anesthesiology Source Type: research

Respiratory Prehabilitation for the Prevention of Postoperative Pulmonary Complications after Major Surgery
AbstractPurpose of ReviewDespite modern advances in perioperative medicine, postoperative pulmonary complications (PPCs) remain a significant problem. This paper reviews the current evidence for respiratory prehabilitation to prevent PPCs in major surgical populations.Recent FindingsA large multicentre international 2018 trial conducted within a modern perioperative framework confirmed previous findings that a physiotherapy-led education and breathing exercise training session delivered in preadmission clinics is a highly cost-effective method to significantly reduce PPC incidence. A 2020 meta-analysis of ten small clinica...
Source: Current Anesthesiology Reports - December 1, 2021 Category: Anesthesiology Source Type: research

The Role of Perioperative Shared Decision Making: When Risk Is Non-modifiable
AbstractPurpose of ReviewThis review describes the need for and yet the challenges inherent in operationalising shared decision making (SDM) in the perioperative setting. A novel approach to the role of SDM in preparing for high-risk surgery is described as well as a pragmatic outline of the individual components that make up this process.Recent FindingsSignificant heterogeneity exists in the literature examining perioperative SDM. Despite the reported benefits, SDM is not being consistently delivered to surgical cohorts. This is primarily related to difficulties in defining and measuring both SDM and associated outcomes p...
Source: Current Anesthesiology Reports - November 29, 2021 Category: Anesthesiology Source Type: research

The Role of Perioperative Shared Decision-making: When Risk Is Non-modifiable
AbstractPurpose of ReviewThis review describes the need for and yet the challenges inherent in operationalising shared decision making (SDM) in the perioperative setting. A novel approach to the role of SDM in preparing for high-risk surgery is described as well as a pragmatic outline of the individual components that make up this process.Recent FindingsSignificant heterogeneity exists in the literature examining perioperative SDM. Despite the reported benefits, SDM is not being consistently delivered to surgical cohorts. This is primarily related to difficulties in defining and measuring both SDM and associated outcomes p...
Source: Current Anesthesiology Reports - November 29, 2021 Category: Anesthesiology Source Type: research

Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review
AbstractPurpose of ReviewThe aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes.Recent FindingsPreoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote retur...
Source: Current Anesthesiology Reports - November 25, 2021 Category: Anesthesiology Source Type: research

Cardiopulmonary Exercise Testing and Other Tests of Functional Capacity
AbstractPurpose of ReviewAssessment of functional capacity is a cornerstone of preoperative risk assessment. While subjective clinician assessment of functional capacity is poorly predictive of postoperative outcomes, other objective functional assessment measures may provide more useful information.Recent FindingsCardiopulmonary exercise testing (CPET) is generally accepted as the gold standard for functional capacity assessment. However, CPET is resource-intensive and not universally available. Simpler objective tests of functional capacity such as the Duke Activity Status Index (DASI) and the 6-min walk test (6MWT) are ...
Source: Current Anesthesiology Reports - November 20, 2021 Category: Anesthesiology Source Type: research

Coagulation and Aging: Implications for the Anesthesiologist
AbstractPurpose of ReviewThis narrative review focuses on aging-related modifications in coagulation resulting in increased thromboembolic and hemorrhagic risk of the elderly. We further discuss the current evidence and emerging data relating the perioperative treatment of elderly patients with antithrombotic therapy.Recent FindingsRelevant changes in all elements of the Virchow ’s triad can be found with aging. Increased blood stasis due to immobility, progressive endothelial dysfunction with altered microcirculation, elevated concentrations of several coagulation factors, and increased platelet reactivity all lead ...
Source: Current Anesthesiology Reports - November 19, 2021 Category: Anesthesiology Source Type: research

Neurological Aging and Pharmacological Management of Geriatric Patients
AbstractPurpose of ReviewThis review will focus on changes in nervous system with aging, alteration in neuro-connectivity with aging, changes in dosing of anesthetic drugs with aging, and current practice patterns of anesthetic drug dosing in the elderly patients.Recent FindingsNeuro-connectivity continues to evolve throughout the life span. After the age of 40 years, functional connectivity becomes less segregated and specific. Evaluation of current practice patterns suggest that practitioners are liberal in administering anesthetics in the elderly patients and frequently exceed the recommended dose range.SummaryFunctiona...
Source: Current Anesthesiology Reports - November 11, 2021 Category: Anesthesiology Source Type: research

Preoperative Risk Assessment and Prehabilitation in Developing (Low and Middle Income) Countries for Improved Surgical Outcomes
AbstractPurpose of ReviewThis review attempts to illustrate the importance of preoperative risk stratification and prehabilitation in improving post-surgical outcomes in developing countries. It analyzes the unique challenges faced in developing countries and measures required to improve outcomes with limited resources.Recent FindingsPreoperative risk stratification has been found to utilize healthcare resources efficiently to those in need. Prehabilitation strategies positively influence baseline functional status of high-risk patients and improve post-surgical outcomes. Healthcare resources in developing countries are st...
Source: Current Anesthesiology Reports - November 8, 2021 Category: Anesthesiology Source Type: research

Protein for the Pre-Surgical Cancer Patient: a Narrative Review
AbstractPurpose of ReviewPrehabilitation prepares patients to withstand the rigors of surgery; however, there is little consensus on nutritional prehabilitative support for surgical patients. In this narrative review, we offer our perspectives on the role of protein in surgical prehabilitation.Recent FindingsWhile the exact dietary protein requirements of pre-surgical patients are unknown, protein is an important piece of any nutritional care plan. Body protein, in particular skeletal muscle, is catabolized to support surgery-related systemic responses such as inflammation and wound healing. Older adults and patients with ...
Source: Current Anesthesiology Reports - November 4, 2021 Category: Anesthesiology Source Type: research

Introduction to Pre-operative Exercise Prescription and Physical Activity Promotion for Clinicians and Exercise Professionals
AbstractPurpose of reviewThis review aims to provide clinicians that work in the surgical realm with relevant exercise principles and related research as they consider incorporating prehabilitation into care plans.Recent FindingsExercise is a core component of preoperative health optimization strategies referred to as prehabilitation. The exercise component of prehabilitation aims to improve systemic and loco-regional fitness to increase surgical tolerance and facilitate recovery. Studies demonstrate that greater presurgical physical fitness is associated with improved postsurgical treatment complication rates, recovery, a...
Source: Current Anesthesiology Reports - November 1, 2021 Category: Anesthesiology Source Type: research

The Hidden Pandemic: the Cost of Postoperative Complications
AbstractPurpose of ReviewPopulation-based increases in ageing and medical co-morbidities are expected to substantially increase the incidence of expensive postoperative complications. This threatens the sustainability of essential surgical care, with negative impacts on patients ’ health and wellbeing.Recent FindingsIdentification of key high-risk areas, and implementation of proven cost-effective strategies to manage both outcome and cost across the end-to-end journey of the surgical episode of care, is clearly feasible. However, good programme design and formal cost-effectiveness analysis is critical to identify, a...
Source: Current Anesthesiology Reports - November 1, 2021 Category: Anesthesiology Source Type: research

Preoperative Aerobic Exercise Therapy Prior to Abdominal Surgery: What Is the Evidence? What Dose?
AbstractPurpose of ReviewThis review aims to provide an overview of the current evidence for the clinical utility of aerobic exercise therapy and discuss the practical considerations for prescribing exercise in the preoperative, intra-abdominal surgery setting.Recent FindingsThere is a strong physiological rationale for exercise medicine and the association with significant and numerous health benefits in patient populations. Considerable heterogeneity exists in the prescription of exercise in the current literature. Due to the heterogeneity of preoperative exercise medicine research, there has been a paucity of detailed l...
Source: Current Anesthesiology Reports - November 1, 2021 Category: Anesthesiology Source Type: research

Multimodal Prehabilitation: a Mini Review of Contemporary Research
AbstractPurpose of the ReviewCombining interventions into a multimodal prehabilitation approach is recommended to maximize benefits due to synergistic and cumulative effects of modalities. The purpose of this review was to (i) highlight the rationale for multimodal prehabilitation, (ii) summarize related contemporary literature, and (iii) discuss emerging modalities that may be combined into a comprehensive, personalized prehabilitation program.Recent FindingsOur systematic search of multimodal prehabilitation literature over the past 5  years yielded 11 studies: five randomized controlled trials, four systematic revi...
Source: Current Anesthesiology Reports - November 1, 2021 Category: Anesthesiology Source Type: research

Prehabilitation in the Older People: Current Developments
AbstractPurpose of ReviewThis review aims to provide an overview of the current evidence for prehabilitation in frail, older surgical patients and to provide a pragmatic approach for implementation into routine perioperative care.Recent FindingsThere is increasing evidence for the use of prehabilitation strategies to improve postoperative outcomes. However, there is heterogeneity in the components of prehabilitation programs studied. Furthermore, they have not been robustly examined in a frail older population.SummaryOlder patients are frequently frail and at increased risk of adverse postoperative outcomes. This group may...
Source: Current Anesthesiology Reports - October 30, 2021 Category: Anesthesiology Source Type: research

Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward
AbstractPurpose of ReviewThis review illustrates the evolution and progress with standardization of fellowship education in neuroanesthesiology. It provides a structured discussion around the need for curricula and framework which individual training programs in neuroanesthesiology can use to meet defined educational standards thus meeting criteria for accreditation.Recent FindingsNeuroanesthesiology training has traditionally been heterogenous around the world but international efforts from the community of neuroanesthesiology have culminated in the development of an international council for perioperative training in neu...
Source: Current Anesthesiology Reports - October 26, 2021 Category: Anesthesiology Source Type: research

Role of Transcranial Doppler in Cardiac Surgery Patients
AbstractPurpose of ReviewThis review discusses applications of transcranial Doppler (TCD) in cardiac surgery, its efficacy in preventing adverse events such as postoperative cognitive decline and stroke, and its impact on clinical outcomes in these patients.Recent FindingsTCD alone and in combination with other neuromonitoring modalities has attracted attention as a potential monitoring tool in cardiac surgery patients. TCD allows not only the detection of microemboli and measurement of cerebral blood flow velocity in cerebral arteries but also the assessment of cerebral autoregulation.SummaryNeuromonitoring is critically ...
Source: Current Anesthesiology Reports - October 18, 2021 Category: Anesthesiology Source Type: research

Revisiting Pediatric NPO Guidelines: a 5-Year Update and Practice Considerations
AbstractPurpose of ReviewFrom 2018 to 2019, several international pediatric anesthesia societies challenged the current fasting guidelines, moving to decrease the fasting increment for clear liquids to 1 hour (h). Both the American Society of Anesthesiologists (ASA) and the Society for Pediatric Anesthesia (SPA) have hesitated to change, citing insufficient support. We sought to better understand the evidence related to fasting in children.Recent FindingsWe reviewed the literature from the past 5  years and conducted an informal survey of 51 United States (US) pediatric medical centers. Some medical institutions in th...
Source: Current Anesthesiology Reports - October 12, 2021 Category: Anesthesiology Source Type: research

Mechanisms, Diagnosis, and Medical Management of Hyperalgesia: an Educational Review
AbstractPurpose of the ReviewHyperalgesia may be an iatrogenic consequence of surgery or pain management. Thus, it is essential for anesthesiologists, pain management specialists, surgeons, and primary care physicians to regularly update their awareness and strategies for addressing this problem. This educational review of hyperalgesia provides up-to-date knowledge of the contributing mechanisms, differential diagnoses, and medical therapy. A particular focus is placed on common types of postoperative hyperalgesia and recent evidence that anesthesiologists and surgeons should be aware of.Recent FindingsHyperalgesia may acu...
Source: Current Anesthesiology Reports - October 11, 2021 Category: Anesthesiology Source Type: research

Mechanical Cardiac Circulatory Support: an Overview of the Challenges for the Anesthetist
AbstractPurpose of ReviewOwing to increased utilization of Mechanical Circulatory Support (MCS) devices, patients with these devices frequently present for surgeries requiring anesthetic support. The current article provides basics of perioperative management of these devices.Recent FindingsUse of extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs) are on the rise with recently updated management guidelines. Veno-venous ECMO utilization has been widely utilized as a salvage therapy during the COVID-19 pandemic.SummaryIntra-Aortic Balloon Pumps continue to be one of the most frequently use...
Source: Current Anesthesiology Reports - October 1, 2021 Category: Anesthesiology Source Type: research

Regional Anesthesia for Total Hip Arthroplasty: Essential Anatomy, Techniques, and Current Literature Review
AbstractPurpose of ReviewTotal hip arthroplasty (THA) is one of the most common joint arthroplasty surgical procedures. The goal of achieving adequate acute pain management in the post-operative setting remains a challenge. The purpose of this literature review was to examine the different modes of analgesia that are used to manage post-operative pain in patients undergoing hip surgery, primarily THA.Recent FindingsTo date, there exists no gold standard regional or multimodal pain regimen used for patients undergoing THA. Combining peripheral nerve blocks (PNB) with adjunctive measures such as local infiltration analgesia,...
Source: Current Anesthesiology Reports - September 28, 2021 Category: Anesthesiology Source Type: research

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