Novel Oxygenation Techniques for Airway Management
AbstractPurpose of ReviewSignificant morbidity is caused by hypoxemic events during procedural sedation, induction for tracheal intubation, and postoperatively after anesthesia in the postoperative care unit. Novel and advanced oxygenation techniques will be discussed to help prevent hypoxemia and improve patient outcome.Recent FindingsASA closed claims outside the operating room showed an increase in oxygen desaturation during moderate to deep sedation with no or conventional oxygenation. Non-invasive positive pressure oxygenation (NPPO) reduces the incidence of oxygen desaturation during procedural sedation, during induc...
Source: Current Anesthesiology Reports - September 22, 2020 Category: Anesthesiology Source Type: research
A Practical Approach to Assessment and Management of Patients at Risk for Non-medical Opioid Use: a Focus on the Patient with Cancer-Related Pain
AbstractPurpose of ReviewOver the past decade, the perception of prescription opioids changed dramatically. Once considered a savior from all types of pain, with few side effects and no celling dose, opioids are now restricted by many states, health insurance companies, and pharmacies. This narrative review aims to synthesize the latest evidence for managing oncology patients at risk for non-medical opioid use (NMOU).Recent FindingsOpioids are effective medications for reducing severe cancer pain, despite their side effects. Screening tools identify high-risk patients, and a nomogram is available, using routine clinical da...
Source: Current Anesthesiology Reports - September 10, 2020 Category: Anesthesiology Source Type: research
The Potential Role of Dual Mechanistic Opioids in Combating Opioid Misuse
AbstractPurposeIn the last years, the consumption of opioid analgesics in western countries, particularly in USA, has dramatically increased, and this rise has been paralleled by a proportional number of opioid-related deaths. To response to this health crisis, opioid guidelines have been developed to reduce the risk of harm related to opioid prescribing. Many activities have been suggested to face opioid epidemic. Clinicians should find a proper balance that meets the patient ’s need for pain relief while minimizing abuse. The aim of this review was to examine the value of so-called dual opioids in this contextRecent Fi...
Source: Current Anesthesiology Reports - September 8, 2020 Category: Anesthesiology Source Type: research
Optimizing Perioperative Use of Opioids: a Multimodal Approach
AbstractPurpose of ReviewThe main purpose of this article is to review recent literature regarding multimodal analgesia medications, citing their recommended doses, efficacy, and side effects. The second part of this report will provide a description of drugs in different stages of development which have novel mechanisms with less side effects such as tolerance and addiction.Recent FindingsMultimodal analgesia is a technique that facilitates perioperative pain management by employing two or more systemic analgesics along with regional anesthesia, when possible. Even though opioids and non-opioid analgesics remain the most ...
Source: Current Anesthesiology Reports - September 6, 2020 Category: Anesthesiology Source Type: research
Ultrasound in Airway Management
AbstractPurpose of ReviewClinical application of ultrasound (US) in airway management has continued to expand and evolve over the years. Our narrative aims to provide an updated summary of the role of airway US in current anesthesia practice, based on evidence published in the recent 5 years.Recent FindingsEvidence continues to support the use of US in identifying the cricothyroid membrane and tracheal interspace for infraglottic airway access. While US shows potential in improving the accuracy of prediction of difficult airways, no standardized scanning protocol has yet to be created. Other promising clinical applicatio...
Source: Current Anesthesiology Reports - September 6, 2020 Category: Anesthesiology Source Type: research
Management of the Difficult Pediatric Airway
AbstractPurpose of ReviewThis review discusses the most current relevant literature regarding management of the difficult pediatric airway.Recent FindingsPeriodic review of the latest research ensures that anesthesia providers are educated on the most current practices. The review will provide practical evidence to support the use of various devices and techniques, including video laryngoscopy, flexible fiberoptic bronchoscopy, apneic oxygenation, use of neuromuscular blockade, ultrasound, and more. A simple algorithm for managing the difficult pediatric airway is also provided. Understanding the risk factors for the diffi...
Source: Current Anesthesiology Reports - September 4, 2020 Category: Anesthesiology Source Type: research
Extubation of the Challenging or Difficult Airway
AbstractPurpose of ReviewThis review explores relevant definitions, epidemiology, management, and potential future research directions in the extubation of the challenging/difficult airway. It provides guidance on identifying patients at risk and how to approach these clinical scenarios.Recent FindingsBased on recent literature, including large-scale audits and closed claims analysis, it is increasingly recognized that extubation of the difficult airway is a situation at risk of severe adverse events. Some strategies to manage the extubation of the challenging/difficult airway have been described.SummaryExtubating the chal...
Source: Current Anesthesiology Reports - September 3, 2020 Category: Anesthesiology Source Type: research
Distractions in the Operating Room
AbstractPurpose of ReviewThe goal of this review is to investigate current research in the area of operating room (OR) distractions, in particular, from the perspective of the anesthesia provider. Additionally, the concept of the “sterile cockpit” is discussed as well as the science of attention span in humans.Recent FindingsEtiology of distractions may be classified as patient care related, due to technology, noise, and alarms, from interpersonal dynamics or personally driven. Studies show that at least 5% of human factor errors in the OR are due to distractions. Lack of attention has been shown to contribute dispropo...
Source: Current Anesthesiology Reports - September 3, 2020 Category: Anesthesiology Source Type: research
Alcohol, Tobacco, and Substance Use and Association with Opioid Use Disorder in Patients with Non-malignant and Cancer Pain: a Review
AbstractPurpose of ReviewThe following review will highlight recent studies reporting associations between alcohol and tobacco use with non-medical opioid use in the post-operative period, as well as patients with chronic non-malignant and cancer pain.Recent FindingsThe use of alcohol, tobacco, and other illegal substances are associated with an increased risk of opioid use disorder in the post-operative setting and in patients with chronic non-malignant and cancer pain.SummaryOpioid overdoses are at a national epidemic afflicting the general population. A comprehensive assessment of the risk for opioid use disorder is adv...
Source: Current Anesthesiology Reports - September 3, 2020 Category: Anesthesiology Source Type: research
Vascular Air Emboli During the Perioperative Period
AbstractPurpose of ReviewVascular air embolism is of particular concern to the anesthesiologist. The unique combination of factors encountered during procedures requiring sedation or general anesthesia increases the risk for its occurrence. Air embolism can have devastating consequences and result in morbidity and even mortality. Prevention and early diagnosis are key in mitigating the effects of this event. This manuscript provides a comprehensive review of the current knowledge and new developments in vascular air embolism.Recent FindingsOur understanding of procedures during which vascular air embolism can occur has exp...
Source: Current Anesthesiology Reports - September 2, 2020 Category: Anesthesiology Source Type: research
Airway Management in out of the Operating Room Environments
AbstractPurpose of ReviewThis review explores the expanding considerations and techniques for airway management of patients in remote settings outside of the operating room (OR). These environments bring various challenges for the patient as well as practitioner and it is essential to proceed safely.Recent FindingsNew developments in patient monitoring, oxygen delivery, and airway adjuncts have provided solutions to the many challenges involved in management of the airway in remote environments. These devices and techniques may have had their origins in the operating room but are uniquely applicable to outside locations. C...
Source: Current Anesthesiology Reports - September 2, 2020 Category: Anesthesiology Source Type: research
Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety
AbstractPurpose of ReviewWe aim to (1) identify the benefits and risks of patient-controlled analgesia and (2) analyze the risks of using various modalities of PCA among patients with traumatic injuries, sleep apnea, chronic pain, or neuropathies.Recent FindingsAn oral sufentanil PCA system may be as effective as an intravenous PCA. The overall incidence of PCA device error is less than 1%. While IV PCA may not be more effective than nurse-administered opioid among trauma patients, thoracic epidural analgesia may improve outcomes. Patients with obstructive sleep apnea or obesity are at increased risk of opioid-induced resp...
Source: Current Anesthesiology Reports - August 31, 2020 Category: Anesthesiology Source Type: research
An Update on Systemic Sclerosis and its Perioperative Management
AbstractPurpose of ReviewSystemic sclerosis or scleroderma (SSc) is a systemic, immune-mediated disease characterized by abnormal cutaneous and organ-based fibrosis that results in progressive end-organ dysfunction and decreased survival. SSc results in significant challenges for the practicing anesthesiologist due to its rarity, multi-system involvement, and limited evidence-based guidance for optimal perioperative care. In this update, we briefly discuss the recent evidence on the pathophysiology and current management of SSc, review the anesthesia-related literature, and extrapolate these observations into an optimal pe...
Source: Current Anesthesiology Reports - August 28, 2020 Category: Anesthesiology Source Type: research
Heparin Induced Thrombocytopenia for the Perioperative and Critical Care Clinician
AbstractPurpose of ReviewThis review will illustrate the importance of heparin-induced thrombocytopenia in the intraoperative and critical care settings.Recent FindingsHeparin-induced thrombocytopenia (HIT) occurs more frequently in surgical patients compared with medical patients due to the inflammatory release of platelet factor 4 and perioperative heparin exposure. Recognition of this disease requires a high index of suspicion. Diagnostic tools and therapeutic strategies have been expanded and refined in recent years.SummaryHIT is a condition where antibodies against the heparin/platelet factor 4 complex interact with p...
Source: Current Anesthesiology Reports - August 28, 2020 Category: Anesthesiology Source Type: research
Airway Leads and Airway Response Teams: Improving Delivery of Safer Airway Management?
AbstractPurpose of ReviewAirway management remains a source of significant morbidity and mortality. This review considers recent summaries of complications and looks toward strategies to improve practice using a coordinated approach.Recent FindingsA safety gap can exist between national recommendations and local practice. A lack of attention to end tidal carbon dioxide has repeatedly contributed to airway mismanagement. Clinicians must be trained in newer airway devices (videolaryngoscopes or supraglottic airways) to use them effectively. Time must be found to teach rarely performed skills (e.g., front-of-neck access). Bot...
Source: Current Anesthesiology Reports - July 19, 2020 Category: Anesthesiology Source Type: research
