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 to a...
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, and i...
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 reviews,...
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 the US...
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
