Dexmedetomidine in Modern Neuroanesthesia Practice
AbstractPurpose of ReviewThe purpose of this review is to discuss the role of dexmedetomidine in various procedures in clinical neurosciences. It also gives an overview of the various neurosurgical procedures where dexmedetomidine has been used perioperatively.Recent FindingsDexmedetomidine possesses many properties that are advantageous for neurosurgical patient including its neuroprotective effect. Its role in the cerebral vasospasm has recently become an area of interest for the researchers. There are number of animal as well as human studies where authors observed an improved neurological outcome following administrati...
Source: Current Anesthesiology Reports - May 7, 2021 Category: Anesthesiology Source Type: research
Anesthesia for Endovascular Neurosurgery
AbstractPurpose of ReviewThis review considers important aspects in the provision of anesthesia for endovascular neurosurgery. Subject literature was reviewed to include important publications which have influenced neuro-interventional practice alongside recent meta-analyses to provide a contemporaneous evidence-based review.Recent FindingsThe scope of endovascular neurosurgery and interventional neuro-radiology continues to expand. The advancement of catheter and imaging technologies, alongside the development of novel techniques, has allowed a minimally invasive endovascular approach to be applied to pathologies previous...
Source: Current Anesthesiology Reports - May 6, 2021 Category: Anesthesiology Source Type: research
Author Correction: Pharmacologic Prevention and Treatment of Postpartum Hemorrhage
A Correction to this paper has been published:https://doi.org/10.1007/s40140-021-00449-2 (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - April 28, 2021 Category: Anesthesiology Source Type: research
Sedation in the Intensive Care Unit
AbstractPurpose of ReviewThis narrative review illustrates literature over the last 5 years relating to sedation delivery to mechanically ventilated adult patients in intensive care units.Recent FindingsThere has been an increase in dexmedetomidine-related publications but although systematic reviews suggest dexmedetomidine reduces delirium, agitation, and length of stay, clinical trials have not supported these findings. It is likely to be useful for the managing patients with persisting agitation. Guidelines continue to recommend lightly sedating patients but considerable variation remains in clinical practice and in res...
Source: Current Anesthesiology Reports - April 24, 2021 Category: Anesthesiology Source Type: research
Airway Management in the Critically Ill Patient
AbstractPurpose of ReviewThis paper will evaluate the recent literature and best practices in airway management in critically ill patients.Recent FindingsCardiac arrest remains a common complication of intubation in these high-risk patients. Patients with desaturation or peri-intubation hypotension are at high risk of cardiac arrest, and each of these complications have been reported in up to half of all intubations in critically ill patient populations.SummaryThere have been significant advances in preoxygenation and devices available for performing laryngoscopy and rescue oxygenation. However, the risk of cardiovascular ...
Source: Current Anesthesiology Reports - April 19, 2021 Category: Anesthesiology Source Type: research
Anesthesia for Acute Ischemic Stroke: Updates and Ongoing Debates
AbstractPurpose of ReviewAdvancements in stroke therapeutics and endovascular therapy in the last decade have dramatically changed the management of acute ischemic stroke, the structure of stroke care pathways, and demand for anesthesia resources. This review outlines the evolving perspectives on anesthetic management for the thrombectomy patient, including areas of debate, current recommendations, and future directions for research.Recent FindingsKey concepts in stroke care include immediate medical attention, emergent transfer to a stroke facility, physiologic and hemodynamic stabilization, and rapid recanalization. Alth...
Source: Current Anesthesiology Reports - April 8, 2021 Category: Anesthesiology Source Type: research
Pharmacologic Prevention and Treatment of Postpartum Hemorrhage
AbstractPurpose of ReviewThe purpose of this review is to synthetize the latest evidence on the pharmacological management of postpartum hemorrhage (PPH) and apply it to the clinical context.Recent FindingsThe incidence of PPH in the developed world is rising. Oxytocin and its analogue carbetocin remain the number one choice as first-line uterotonics for the prevention of PPH due to excellent clinical efficacy and a favorable side effect profile. Doses of oxytocin and carbetocin currently recommended for prophylaxis are in excess to that required for clinical efficacy. There is no robust evidence suggesting that one second...
Source: Current Anesthesiology Reports - March 29, 2021 Category: Anesthesiology Source Type: research
Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome
AbstractPurpose of ReviewTo review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously.Recent FindingsObservational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpubl...
Source: Current Anesthesiology Reports - March 3, 2021 Category: Anesthesiology Source Type: research
Enhanced Recovery After Cesarean: Current and Emerging Trends
AbstractPurpose of ReviewWhat are the latest enhanced recovery elements for cesarean delivery?Recent FindingsEnhanced recovery after cesarean delivery (ERAC) provides an evidenced-based system to improve maternal outcomes, functional recovery, maternal-infant bonding, and patient experience. Postsurgical recovery has evolved from a one-dimensional pain score to a holistic multidimensional approach emphasizing faster functional recovery. ERAC involves multidisciplinary efforts of the anesthesiologist, obstetrician, nursing, hospital, and patient. Components of ERAC include preoperative patient education, limited fasting, ca...
Source: Current Anesthesiology Reports - March 2, 2021 Category: Anesthesiology Source Type: research
High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review
AbstractPurpose of ReviewThis review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic.Recent FindingsGlobally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive s...
Source: Current Anesthesiology Reports - March 2, 2021 Category: Anesthesiology Source Type: research
Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review
AbstractPurpose of ReviewTo highlight the challenges associated with providing sedation and analgesia to critically ill patients with coronavirus disease 2019 (COVID-19) and also understand the pathophysiological alterations induced by the disease process as well as the logistical difficulties encountered by providers caring for these patients. We also discuss the rationale and risks associated with the use of common sedative agents specifically within the context of COVID-19 and provide evidence-based management strategies to help manage sedation and analgesia in such patients.Recent FindingsA significant proportion of pa...
Source: Current Anesthesiology Reports - February 26, 2021 Category: Anesthesiology Source Type: research
Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance
This article aims to describe the role of anesthesiologists on current standards of infection prevention and sterility as well as ongoing developments in resource-limited settings, with a focus on LMICs.Recent FindingsRecent estimates indicate a threefold increase in the incidence of SSI across LMICs over the past two decades, approaching two times the estimated SSI incidence of high-income countries. As a result, public health officials have promoted standard practices for infection prevention in the surgical arena by creating multidisciplinary teams and tailoring to the availability of equipment and resources. Anesthesio...
Source: Current Anesthesiology Reports - February 26, 2021 Category: Anesthesiology Source Type: research
Perioperative Management of Severe Acquired Coagulopathy in Patients with Left Ventricular Assist Device —a Literature Review and Expert Recommendations
AbstractPurpose of This ReviewThe implantation of a left ventricular assist device (LVAD) is associated with high hemorrhage-related re-exploration rates. Improved management of coagulopathy may improve patient outcome. The optimal management of acquired coagulopathy in LVAD patients needing urgent non-cardiac surgery needs to be defined. We aim to review risk factors for perioperative bleeding and diagnosis and management of LVAD-associated coagulopathy and to provide expert recommendations for clinical practice.Recent FindingsIn patients undergoing LVAD implantation, the severity of coagulopathy is directly related to th...
Source: Current Anesthesiology Reports - February 24, 2021 Category: Anesthesiology Source Type: research
The Current Role of General Anesthesia for Cesarean Delivery
AbstractPurpose of the ReviewThe use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this rev...
Source: Current Anesthesiology Reports - February 24, 2021 Category: Anesthesiology Source Type: research
The Role of Truncal Blocks in Obstetric Anesthesia
AbstractPurpose of ReviewThis review provides a framework for managing post-cesarean delivery pain in the age of enhanced recovery after surgery (ERAS). In doing so, it highlights the role that truncal blocks play in obstetric anesthesia. The value of transversus abdominus plane block (TAP) and quadratus lumborum block (QLB) to optimize post-cesarean delivery pain is discussed.Recent FindingsTAP block and QLB have been compared with each other and with controls, with and without neuraxial morphine. In the absence of neuraxial morphine, TAP block and QLB are superior to controls, but when intrathecal morphine is used, they ...
Source: Current Anesthesiology Reports - February 18, 2021 Category: Anesthesiology Source Type: research
