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 3, 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 3, 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 - March 31, 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 30, 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 30, 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 26, 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 26, 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 22, 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 19, 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 low-dose fou...
Source: Current Anesthesiology Reports - March 17, 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 16, 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 13, 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 5, 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 3, 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 2, 2020 Category: Anesthesiology Source Type: research
