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 20, 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 11, 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 11, 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 11, 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 8, 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 4, 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 4, 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 - April 1, 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 31, 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 31, 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 27, 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 27, 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 23, 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 20, 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 18, 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 17, 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 14, 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 6, 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 4, 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 3, 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 27, 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 24, 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 17, 2020 Category: Anesthesiology Source Type: research

Role of Point-of-Care Ultrasound in the Early Stages of Trauma Care
AbstractPurpose of ReviewPoint-of-care ultrasound (POCUS) has been widely adopted in the management of trauma patients by emergency and surgical specialists. Advances in technology, portability, and affordability have contributed to its exponential growth, particularly in the field of trauma anesthesia where ultrasound usage has steadfastly blossomed in recent years.Recent FindingsStudies and protocols have expanded beyond the oft-used focused assessment with sonography for trauma examination to include focused cardiac and lung examinations. POCUS may also be useful as an adjunct for airway management, vascular access, and...
Source: Current Anesthesiology Reports - January 17, 2020 Category: Anesthesiology Source Type: research

Author Correction: Maternal Sepsis: Recognition, Treatment, and Escalation of Care
The original version of this article contained two mistakes. In Table 2, under the “MEW criteria” heading, “DBP 100 mmHg. ” The correct Table 2 is shown here. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - January 16, 2020 Category: Anesthesiology Source Type: research

Anesthetic Care for the Post-concussive Patient: There Are More Questions Than Answers
AbstractPurpose of ReviewThis review informs the practicing clinician regarding the pathophysiology of mild traumatic brain injury and its implication on the anesthetic management of patients presenting for surgery. It highlights several areas where data is sparse that might spark the interest of researchers. It proposes a broad guideline for managing patients who present for surgery.Recent FindingsThe post-concussive brain has a vulnerable window of risk in which secondary insult might worsen long-term outcome. Scheduling elective surgery beyond this window of vulnerability might be beneficial. Several biomarkers may prov...
Source: Current Anesthesiology Reports - January 15, 2020 Category: Anesthesiology Source Type: research

Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries
This article provides an overview of the common and important chest injuries that the anesthesiologist may encounter in patients following trauma including blunt injury, pneumothorax, hemothorax, blunt aortic injury, and blunt cardiac injury.Recent FindingsRib fractures are frequently associated with chest injury and are associated with significant pain and other complications. Regional anesthesia techniques combined with a multimodal analgesic strategy can improve patient outcomes and reduce complications. There is increasing evidence for paravertebral blocks for this indication, and the myofascial plane blocks are a popu...
Source: Current Anesthesiology Reports - January 15, 2020 Category: Anesthesiology Source Type: research

Improving Surgical Outcomes and Patient Health: Perioperative Smoking Cessation Interventions
AbstractPurpose of ReviewThis review is aimed at discussing the evidence for perioperative smoking cessation interventions and at describing the components of an effective, multimodal smoking cessation intervention.Recent FindingsThe increased risks associated with smoking around the time of surgery are well established. There is strong evidence for the benefits of perioperative smoking cessation interventions, which include increasing smoking abstinence and decreasing surgical complications. Interventions should aim to start at least 4  weeks preoperatively and provide ongoing support; however, starting any time befo...
Source: Current Anesthesiology Reports - January 14, 2020 Category: Anesthesiology Source Type: research

Preoperative Airway Evaluation
AbstractPurpose of ReviewThis paper provides an updated review on preoperative airway assessment, the factors that are used to predict a difficult airway, and whether difficulty can be accurately predicted.Recent FindingsTraditional history and examination features have focused on prediction of difficult intubation, but recent studies attempt to predict difficulty with other aspects of managing the airway including bag-mask ventilation, supraglottic airway (SGA) ventilation, and front-of-neck access. A recent Cochrane review confirms that traditional examination findings lack diagnostic accuracy for detection of difficult ...
Source: Current Anesthesiology Reports - January 11, 2020 Category: Anesthesiology Source Type: research

Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders
AbstractPurpose of ReviewThis review summarizes selected recent evidence on issues important for preoperative pain evaluation.Recent FindingsOpioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied.SummaryPreoperative pain and psychological f...
Source: Current Anesthesiology Reports - January 10, 2020 Category: Anesthesiology Source Type: research

Correction to: Quadratus Lumborum Block: a Technical Review
The article Quadratus Lumborum Block: a Technical Review, written by Avni Gupta, Rakesh Sondekoppam and Hari Kalagara, was originally published Online First without Open Access. After publication in volume 9, issue 3, page 257 –262 the author. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - November 25, 2019 Category: Anesthesiology Source Type: research

You Are Only as Frail as Your Arteries: Prehabilitation of Elderly Surgical Patients
AbstractPurpose of ReviewTo discuss the concept of prehabilitation for the elderly frail surgical patient as well as strategies to improve preoperative functional capacity and vascular function to decrease postoperative complications.Recent FindingsFrailty is associated with poor surgical outcomes yet there is no consensus on how frailty should be measured or mitigated in the preoperative period. Prehabilitation, or improving functional capacity prior to surgery typically through exercise, has been shown to be an effective strategy to decrease preoperative frailty and improves surgical outcomes. Use of remote ischemic prec...
Source: Current Anesthesiology Reports - November 22, 2019 Category: Anesthesiology Source Type: research

The Role of Extracorporeal Life Support in Thoracic Surgery
AbstractPurpose of ReviewExtracorporeal life support (ECLS) is a widely used potential treatment option in patients with severe respiratory or cardiac failure with increasing significance. Routine perioperative application of ECLS is applied in cardiac and rare in thoracic surgery. This review will address the extracorporeal membrane oxygenation (ECMO) technology and basic concepts, the indications in thoracic surgery, and the intraoperative management of ECMO during surgery. The most common challenges and complications, the postoperative concept, and additional forms of support will be discussed.Recent FindingsTechnologic...
Source: Current Anesthesiology Reports - November 16, 2019 Category: Anesthesiology Source Type: research

Outcomes in Pain Clinical Research: What Really Matters for Patients?
AbstractPurpose of ReviewThe measurement and assessment of pain outcomes is critical to the design, analysis, and interpretation of a pain clinical trial. Results from clinical research impact a number of stakeholders, but it can be argued that patients are the most affected. The purpose of this review is to summarize the most important pain outcomes to patients and discuss methodological considerations in collecting these data in a clinical trial.Recent FindingsWe found that there are a number of outcomes that are important to patients. The outcomes that consistently appear in the literature include reductions in pain int...
Source: Current Anesthesiology Reports - November 15, 2019 Category: Anesthesiology Source Type: research

Infiltration Between the Popliteal Artery and Capsule of the Knee (iPACK): Essential Anatomy, Technique, and Literature Review
AbstractPurpose of ReviewIn this review, we discuss the essential iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) anatomy, block technique as well as potential complications, contraindications, and relevant literature evaluating the efficacy of the iPACK block.Recent FindingsRecent literature supports the efficacy of the iPACK in controlling pain, improving postoperative physical therapy performance, and decreasing hospital length of stay (LOS). Cadaver studies have demonstrated that injection of dye in the tissue plane between the popliteal artery and the femoral shaft cranial to femoral condyles...
Source: Current Anesthesiology Reports - November 12, 2019 Category: Anesthesiology Source Type: research

Pulmonary Hypertension and Thoracic Surgery: Impact and Treatment Options
AbstractPurpose of ReviewThe purpose of this paper is to review updates to the definition of pulmonary hypertension (PH), its diagnosis, and management. New treatment options, the role of mechanical support, outcome studies, and intraoperative management will be emphasized.Recent FindingsThe definition of PH has been recently changed, with a decrease in the qualifying mean pulmonary artery pressure and the addition of pulmonary vascular resistance. There have been minor changes to PH classifications. Some new medications are available to treat PH, and new associations between drugs and PH have been discovered. Recommended ...
Source: Current Anesthesiology Reports - November 11, 2019 Category: Anesthesiology Source Type: research

Perioperative Management of Delirium in Geriatric Patients
AbstractPurpose of ReviewWe review the current literature on predictors, pathophysiology, and prevention of delirium in surgical patients. The focus is on the role of the anesthesiologist in the prevention and management of delirium in the perioperative setting.Recent FindingsRecent literature has examined how surgery and anesthetic management can affect the incidence of delirium. Anesthesiologists play a critical role in identifying those at risk of developing delirium and adjusting their anesthetic management and perioperative course to minimize this risk.SummaryDelirium research is evolving rapidly. Current evidence sug...
Source: Current Anesthesiology Reports - November 11, 2019 Category: Anesthesiology Source Type: research

Hypoxemia During One-Lung Ventilation: Does it Really Matter?
AbstractPurpose of ReviewThe human system of oxygen transport and metabolism is complex, and appropriate means to follow its single steps intraoperatively do not exist. Intraoperative tissue hypoxia is one of the leading dangers for patients receiving one-lung ventilation (OLV). Pulmonary, cerebral, or cardiac injuries may be the result. To summarize the current knowledge about the tolerable human limits of hypoxia, inside and outside the thoracic surgery room, is the purpose of this review.Recent FindingsHigh altitude mountaineers and apnea divers teach us that the healthy human body is able to acclimatize to and cope wit...
Source: Current Anesthesiology Reports - November 7, 2019 Category: Anesthesiology Source Type: research

The Challenge of Perioperative Fluid Management in Elderly Patients
AbstractPurpose of ReviewThe purpose of this chapter is to describe physiological changes occurring with age relevant to fluid therapy, and to discuss the influence of fluid therapy on outcome of surgery from this perspective.Recent FindingsDehydration, common among elderly people, is often mistaken for dementia or depression. Dehydration with dizziness increases the risk of falling, a predictor for adverse outcomes after surgery.Young volunteers can excrete up to 300 mmol sodium per liter urine. Elderly people cannot achieve such a concentration emphasizing the importance of giving water to excrete the osmoles given with ...
Source: Current Anesthesiology Reports - October 31, 2019 Category: Anesthesiology Source Type: research

Emergency General Surgery in Older Patients: Where Are We Now?
AbstractPurpose of ReviewThe purpose of this chapter is to provide a review of the literature around emergency general surgery in older patients.Recent FindingsEmergency general surgery has a high mortality rate and with the population ageing at an unprecedented rate, older patients have an increased mortality risk due to their age alone. Complications are higher and older patients are more likely not to be discharged home following surgery. However, accurately predicting risk of surgery in elderly patients is very difficult. Simple measures such as concurrent comprehensive geriatric assessment with surgical assessment may...
Source: Current Anesthesiology Reports - October 30, 2019 Category: Anesthesiology Source Type: research

Which Anesthesia Regimen Should Be Used for Lung Surgery?
AbstractPurpose of ReviewThe aim of this review is to assess the particularities of general anesthesia for patients undergoing lung surgery and one-lung ventilation (OLV), and to suggest the ideal anesthesia regimen based on the current literature.Recent FindingsPulmonary surgery is often performed using OLV. This is accompanied by specific physiological challenges and risks, principally hypoxemia and acute lung injury (ALI). Anesthetic strategies to prevent ALI include close adjustment of mechanical ventilation settings using low tidal volumes (
Source: Current Anesthesiology Reports - October 28, 2019 Category: Anesthesiology Source Type: research

Serratus Plane Block in the Management of Post-operative Thoracotomy Pain
AbstractPurpose of ReviewThoracotomy surgeries are associated with severe pain in the post-operative period; inadequate control of this pain may give rise to pulmonary complications in the form of lung atelectasis and infection. Presently, regional analgesic techniques are the mainstay therapeutic measures suggested for the management of post-operative pain after thoracotomy.Recent FindingsSerratus anterior plane block has shown good pain relief after thoracotomy and thoracoscopy procedures in many clinical trials and case reports. It involves local anesthetic injection in a plane superficial or deep to the serratus anteri...
Source: Current Anesthesiology Reports - October 28, 2019 Category: Anesthesiology Source Type: research

Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review
This article aims to review the anatomy relevant to the ultrasound techniques of the transversus abdominis plane (TAP) block and rectus sheath block (RSB). We discuss their analgesic efficacy for various surgical procedures, both as single shot and as a continuous infusion via catheters.Recent FindingsRSB provides superior analgesia to local infiltration and has an opioid-sparing effect for umbilical surgery, laparotomy, and laparoscopic surgery. There is no high-quality evidence comparing RSB with epidural analgesia. Intermittent bolus through catheters appears to be more effective than continuous infusion for prolonged a...
Source: Current Anesthesiology Reports - October 25, 2019 Category: Anesthesiology Source Type: research

Perioperative Acute Care of Older Patients Living with Frailty
AbstractPurpose of ReviewFrailty has been independently linked to adverse postoperative outcomes including increased morbidity, mortality, health resource use, and disability. We discuss the data underlying these associations, as well as literature supporting perioperative frailty assessment and perioperative management strategies, with a focus on older people with frailty undergoing elective, non-cardiac surgery.Recent FindingsPerioperative interventions tested to improve outcomes for older people with frailty are limited; interventions proven to improve outcomes are even more rare. Current evidence-based strategies inclu...
Source: Current Anesthesiology Reports - October 24, 2019 Category: Anesthesiology Source Type: research

Positive End-Expiratory Pressure (PEEP), Tidal Volume, or Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation?
AbstractPurpose of ReviewThis review attempts to focus on protective ventilation approaches during one-lung ventilation (OLV) and will summarize recent findings.Recent FindingsRecent studies have demonstrated the importance of low tidal volume (low TV) and reduced driving pressure during OLV. Along with low TV, correct use of positive end-expiratory pressure (PEEP) seems to have a vital role in terms of protecting the ventilated lung. PEEP decremental trial and the use of electrical impedance tomography are prominent techniques for individualizing the PEEP. The use of alveolar recruitment maneuvers (ARMs) is furthermore re...
Source: Current Anesthesiology Reports - October 24, 2019 Category: Anesthesiology Source Type: research

Pediatric Palliative Care in the Perioperative Period
AbstractPurpose of ReviewThe purpose of this review is to familiarize anesthesiologists with the role of the subspecialty of pediatric palliative care and its potential contributions to the management of children with complex and life-threatening illnesses, many of whom may present for operative or diagnostic procedures requiring anesthesia.Recent FindingsRecent publications highlight the benefits of palliative care to patients and families experiencing a wide variety of conditions along the continuum from prenatal application to the management of young adults. Retrospective reports highlight improved quality of life, impr...
Source: Current Anesthesiology Reports - July 27, 2019 Category: Anesthesiology Source Type: research

Experimental Data on the Pulmonary Effects of Remote Ischemic Preconditioning
AbstractPurpose of ReviewRemote ischemic preconditioning (RIP) has been demonstrated to protect against ischemia-reperfusion-injury in different target organs. The mechanisms that eventually lead to these protective effects have been investigated in depth but are not yet fully elucidated. Although the effects of RIP seem to be promising in animal experiments and smaller clinical studies, they failed to achieve clinical significance in multicenter trials. These trials have mainly focused on the heart, the brain, and the kidneys, but only little is known concerning the effects of RIP on the lungs. This review will provide an...
Source: Current Anesthesiology Reports - July 19, 2019 Category: Anesthesiology Source Type: research

Echocardiography in the Intensive Care Unit
AbstractPurpose of ReviewThis review illustrates the incremental value of echocardiography as a bedsite tool for diagnosis and monitoring in critically ill patients with cardiopulmonary dysfunction. It provides practical guidance on the use of basic echocardiography in clinical scenarios frequently encountered in the ICU.Recent FindingsEchocardiography has become readily accessible to critical care physicians now and equipment is even been designed specifically for use in acute and critical care environments. The most important barrier to a more widespread implementation of this technique today, however, is the lack of tra...
Source: Current Anesthesiology Reports - July 18, 2019 Category: Anesthesiology Source Type: research

Metabolic Disorders and Anesthesia
AbstractPurpose of ReviewMetabolic disorders encompass a group of inherited inborn errors of metabolism that are uncommonly encountered but can pose challenges when encountered during the perioperative period. Hence, it is paramount that anesthesiologists are experienced and familiar with management of these conditions.Recent FindingsHundreds of inborn errors of metabolism have already been identified, yet new metabolic disorders continue to be discovered with advancements in genomic science.SummaryIn our general review, we define the more common metabolic disorders encountered in perioperative medicine and discuss the per...
Source: Current Anesthesiology Reports - July 12, 2019 Category: Anesthesiology Source Type: research

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