Perioperative Infection Transmission: the Role of the Anesthesia Provider in Infection Control and Healthcare-Associated Infections
AbstractPurpose of ReviewThis review aims to highlight key factors in the perioperative environment that contribute to transmission of infectious pathogens, leading to healthcare-associated infection. This knowledge will provide anesthesia providers the tools to optimize preventive measures, with the goal of improved patient and provider safety.Recent FindingsOver the past decade, much has been learned about the epidemiology of perioperative pathogen transmission. Patients, providers, and the environment serve as reservoirs of origin that contribute to infection development. Ongoing surveillance of pathogen transmission am...
Source: Current Anesthesiology Reports - July 16, 2020 Category: Anesthesiology Source Type: research
Perioperative Medication Error Prevention
AbstractPurpose of ReviewTo describe the incidence and types of perioperative medication errors and adverse medication events, and to provide a summary of strategies to reduce their incidence.Recent FindingsBetween 4 and 11% of perioperative medications administered may involve a medication error. Methods for detecting medication errors include incident reporting, chart review, direct observation (which is the most sensitive) and engineering modeling techniques. While a paucity of evidence exists to support recommendations to prevent medication errors, consensus recommendations involve process standardization, technology s...
Source: Current Anesthesiology Reports - July 10, 2020 Category: Anesthesiology Source Type: research
The Financial and Humanistic Costs Associated with Residual Neuromuscular Blockade
AbstractPurpose of ReviewTo review the financial and humanistic costs associated with residual neuromuscular blockade (rNMB).Recent FindingsA recent systematic review and meta-analysis of randomized controlled trials suggested that sugammadex was superior to neostigmine in producing faster and more reliable reversal of neuromuscular blockade (NMB).SummaryThe literature on clinical effectiveness of reversal agents, including time to recovery from NMB, time to tracheal extubation, incidence of postoperative residual NMB, and adverse events, indicate that sugammadex is superior to neostigmine. Cost-effectiveness including cos...
Source: Current Anesthesiology Reports - July 3, 2020 Category: Anesthesiology Source Type: research
Physician Burnout: Achieving Wellness for Providers and Patients
AbstractPurpose of ReviewThis review summarizes the history and scope of physician burnout, and explores recent advances in its understanding. With a particular focus on physicians who have completed their training, it also explores the present and future of interventions designed to alleviate the symptoms and sequelae of burnout.Recent FindingsNearly 50 years since first described, burnout continues to remain a pervasive issue within anesthesia and medicine as a whole. Recent work has continued to outline risk factors and specialty-specific prevalence, and explore individual and institutional interventions to prevent an...
Source: Current Anesthesiology Reports - July 2, 2020 Category: Anesthesiology Source Type: research
Blood Conservation in Pediatric Surgical Patients
AbstractPurpose of ReviewPatient blood management (PBM) is an encompassing term to describe strategies to promote blood conservation, reduce unnecessary transfusions, and rationalize the administration of allogeneic blood products. In this review, we will summarize strategies involved in pediatric PBM, including preoperative optimization, intraoperative blood conservation, and systematic institutional interventions.Recent FindingsPreoperative optimization of hemoglobin, along with intraoperative blood conservation strategies, can potentially reduce exposure to allogeneic blood products in pediatric surgical patients. These...
Source: Current Anesthesiology Reports - June 30, 2020 Category: Anesthesiology Source Type: research
The Multiple Casualty Scenario: Role of the Anesthesiologist
AbstractPurpose of ReviewMass casualty disasters (natural and man-made) present an acute, critical situation that taxes healthcare resources and clinician acumen. This review summarizes the characteristics and management skill sets that anesthesiologists possess that make them valuable clinicians during mass casualty events and why we as anesthesiologists must continually educate ourselves on this important topic.Recent FindingsAnesthesiologists should be involved in all aspects of emergency preparedness —mitigation, planning, response, and recovery. The anesthesia department should have a plan for how it will deal with ...
Source: Current Anesthesiology Reports - June 28, 2020 Category: Anesthesiology Source Type: research
History and Practice of Acute Normovolemic Hemodilution
AbstractPurpose for ReviewThe purpose of this review is to provide an overview of recent literature on acute normovolemic hemodilution (ANH) and conclude a consensus of beneficial effects.Recent FindingsNewfound interest in blood conservation has increased the generalizability of ANH. Overall ANH reduces transfusion rate by 20 –30% with a minimum of 650 ml whole blood (WB) removed. Greater effects have also been experienced with ≥ 1000 ml WB. With ANH, allogenic red blood cells (RBCs) and non-RBC transfusion rates are reduced intraoperatively and postoperatively. In addition, decreased length of stay and decreased ...
Source: Current Anesthesiology Reports - June 25, 2020 Category: Anesthesiology Source Type: research
Perioperative Bridging/Cessation of Antiplatelet Agents: 2020 Update
AbstractPurpose of ReviewPerioperative management of patients receiving antiplatelet therapy is common and must carefully balance the risk of ischemia or thrombosis with bleeding. Here we describe pathways of platelet aggregation unique to the perioperative period and mechanisms of commonly encountered antiplatelet medications, and review current literature evaluating strategies for antiplatelet management surrounding elective noncardiac and cardiac surgery.Recent FindingsAntiplatelet therapies demonstrate unique risk profiles for stent thrombosis and bleeding that may be dependent on individual genetic polymorphisms. Use ...
Source: Current Anesthesiology Reports - June 18, 2020 Category: Anesthesiology Source Type: research
Is Fresh Frozen Plasma Still Necessary for Management of Acute Traumatic Coagulopathy?
AbstractPurpose of ReviewMassive blood loss secondary to major trauma is a leading cause of death worldwide. In recent years, multiple different strategies have evolved to counteract this life-threatening condition. In this review, we will review our understanding of trauma-induced coagulopathy and summarize current clinical transfusion regimes utilized in military and civilian settings. We will review currently available blood products used to rectify the coherent disturbances of haemostasis by outlining the characteristics of the different products.Recent FindingsCurrent evidence suggests that fresh frozen plasma and fib...
Source: Current Anesthesiology Reports - June 15, 2020 Category: Anesthesiology Source Type: research
Review of Current Practices of Peripheral Nerve Blocks for Hip Fracture and Surgery
This article aims to describe the anatomical and technical aspects of various regional techniques used for fracture hip and hip surgery. We reviewed the commonly used nerve blocks, interfascial plane blocks and current evidence of their utility in hip fracture patients.Recent FindingsFascia iliaca compartment block (FICB) and femoral nerve block (FNB) are the most commonly used nerve blocks for providing pain relief for hip fracture patients. Supra-inguinal FICB has more consistent spread to all nerves and can enable better pain control. Both the FICB and FNB have shown analgesic efficacy with reduced pain scores, opioid s...
Source: Current Anesthesiology Reports - May 25, 2020 Category: Anesthesiology Source Type: research
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 19, 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 increas...
Source: Current Anesthesiology Reports - May 10, 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 neostigmine. At leas...
Source: Current Anesthesiology Reports - April 10, 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 10, 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 7, 2020 Category: Anesthesiology Source Type: research
