Enhanced Recovery After Surgery
AbstractPurpose of ReviewTo provide a brief summary of the progress of enhanced recovery over the last 5 to 10 years and set out what the future might hold for such programmes.Recent FindingsThere has been significant progress in the adoption of enhanced recovery programmes across multiple surgical specialities. However there is still difficulty in sustaining a target of> 80% compliance, which has been identified through research as the optimal level to observe best patient results. With increasing interest in perioperative medicine and prehabilitation, more focus is being put into enhanced recovery programmes.Summ...
Source: Current Anesthesiology Reports - January 26, 2020 Category: Anesthesiology Source Type: research
Preprocedural Assessment for Patients Anticipating Sedation
AbstractPurpose of ReviewThe purpose of this review is to provide a summary of the recent literature addressing the aims, content, outcomes and quality metrics for presedation evaluation.Recent FindingsThere is a trend towards multidisciplinary development of minimum standards for sedation practice, including presedation assessment. A risk-based paradigm underpins presedation assessment. Improved and validated risk scores are required, especially to predict airway difficulty. There is an increasing focus on skillsets rather than roles. Clinicians should explain the intended depth of sedation, how that may be experienced by...
Source: Current Anesthesiology Reports - January 23, 2020 Category: Anesthesiology Source Type: research
Preoperative Assessment for Inpatients
AbstractPurpose of the ReviewThis chapter will highlight several important concepts that are relevant to the assessment and optimization of hospitalized patients prior to the administration of an anesthetic.Recent FindingsPatients admitted to hospital comprise a unique population. The risk-benefit ratio of pre-procedural investigations and the economic implications of specific management strategies may be significantly different than for patients managed on an ambulatory basis. The anesthesiologist must have a thorough understanding of these factors. Preoperative workflows provide effective coordination of the necessary re...
Source: Current Anesthesiology Reports - January 16, 2020 Category: Anesthesiology Source Type: research
Role of Point-of-Care Ultrasound in the Early Stages of Trauma Care
AbstractPurpose of ReviewPoint-of-care ultrasound (POCUS) has been widely adopted in the management of trauma patients by emergency and surgical specialists. Advances in technology, portability, and affordability have contributed to its exponential growth, particularly in the field of trauma anesthesia where ultrasound usage has steadfastly blossomed in recent years.Recent FindingsStudies and protocols have expanded beyond the oft-used focused assessment with sonography for trauma examination to include focused cardiac and lung examinations. POCUS may also be useful as an adjunct for airway management, vascular access, and...
Source: Current Anesthesiology Reports - January 16, 2020 Category: Anesthesiology Source Type: research
Author Correction: Maternal Sepsis: Recognition, Treatment, and Escalation of Care
The original version of this article contained two mistakes. In Table 2, under the “MEW criteria” heading, “DBP< 100 mmHg ” should read “DBP> 100 mmHg. ” The correct Table 2 is shown here. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - January 15, 2020 Category: Anesthesiology Source Type: research
Anesthetic Care for the Post-concussive Patient: There Are More Questions Than Answers
AbstractPurpose of ReviewThis review informs the practicing clinician regarding the pathophysiology of mild traumatic brain injury and its implication on the anesthetic management of patients presenting for surgery. It highlights several areas where data is sparse that might spark the interest of researchers. It proposes a broad guideline for managing patients who present for surgery.Recent FindingsThe post-concussive brain has a vulnerable window of risk in which secondary insult might worsen long-term outcome. Scheduling elective surgery beyond this window of vulnerability might be beneficial. Several biomarkers may prov...
Source: Current Anesthesiology Reports - January 14, 2020 Category: Anesthesiology Source Type: research
Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries
This article provides an overview of the common and important chest injuries that the anesthesiologist may encounter in patients following trauma including blunt injury, pneumothorax, hemothorax, blunt aortic injury, and blunt cardiac injury.Recent FindingsRib fractures are frequently associated with chest injury and are associated with significant pain and other complications. Regional anesthesia techniques combined with a multimodal analgesic strategy can improve patient outcomes and reduce complications. There is increasing evidence for paravertebral blocks for this indication, and the myofascial plane blocks are a popu...
Source: Current Anesthesiology Reports - January 14, 2020 Category: Anesthesiology Source Type: research
Improving Surgical Outcomes and Patient Health: Perioperative Smoking Cessation Interventions
AbstractPurpose of ReviewThis review is aimed at discussing the evidence for perioperative smoking cessation interventions and at describing the components of an effective, multimodal smoking cessation intervention.Recent FindingsThe increased risks associated with smoking around the time of surgery are well established. There is strong evidence for the benefits of perioperative smoking cessation interventions, which include increasing smoking abstinence and decreasing surgical complications. Interventions should aim to start at least 4 weeks preoperatively and provide ongoing support; however, starting any time before o...
Source: Current Anesthesiology Reports - January 13, 2020 Category: Anesthesiology Source Type: research
Preoperative Airway Evaluation
AbstractPurpose of ReviewThis paper provides an updated review on preoperative airway assessment, the factors that are used to predict a difficult airway, and whether difficulty can be accurately predicted.Recent FindingsTraditional history and examination features have focused on prediction of difficult intubation, but recent studies attempt to predict difficulty with other aspects of managing the airway including bag-mask ventilation, supraglottic airway (SGA) ventilation, and front-of-neck access. A recent Cochrane review confirms that traditional examination findings lack diagnostic accuracy for detection of difficult ...
Source: Current Anesthesiology Reports - January 10, 2020 Category: Anesthesiology Source Type: research
Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders
AbstractPurpose of ReviewThis review summarizes selected recent evidence on issues important for preoperative pain evaluation.Recent FindingsOpioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied.SummaryPreoperative pain and psychological f...
Source: Current Anesthesiology Reports - January 9, 2020 Category: Anesthesiology Source Type: research
Correction to: Quadratus Lumborum Block: a Technical Review
The article Quadratus Lumborum Block: a Technical Review, written by Avni Gupta, Rakesh Sondekoppam and Hari Kalagara, was originally published Online First without Open Access. After publication in volume 9, issue 3, page 257 –262 the author. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - November 24, 2019 Category: Anesthesiology Source Type: research
You Are Only as Frail as Your Arteries: Prehabilitation of Elderly Surgical Patients
AbstractPurpose of ReviewTo discuss the concept of prehabilitation for the elderly frail surgical patient as well as strategies to improve preoperative functional capacity and vascular function to decrease postoperative complications.Recent FindingsFrailty is associated with poor surgical outcomes yet there is no consensus on how frailty should be measured or mitigated in the preoperative period. Prehabilitation, or improving functional capacity prior to surgery typically through exercise, has been shown to be an effective strategy to decrease preoperative frailty and improves surgical outcomes. Use of remote ischemic prec...
Source: Current Anesthesiology Reports - November 21, 2019 Category: Anesthesiology Source Type: research
The Role of Extracorporeal Life Support in Thoracic Surgery
AbstractPurpose of ReviewExtracorporeal life support (ECLS) is a widely used potential treatment option in patients with severe respiratory or cardiac failure with increasing significance. Routine perioperative application of ECLS is applied in cardiac and rare in thoracic surgery. This review will address the extracorporeal membrane oxygenation (ECMO) technology and basic concepts, the indications in thoracic surgery, and the intraoperative management of ECMO during surgery. The most common challenges and complications, the postoperative concept, and additional forms of support will be discussed.Recent FindingsTechnologic...
Source: Current Anesthesiology Reports - November 15, 2019 Category: Anesthesiology Source Type: research
Outcomes in Pain Clinical Research: What Really Matters for Patients?
AbstractPurpose of ReviewThe measurement and assessment of pain outcomes is critical to the design, analysis, and interpretation of a pain clinical trial. Results from clinical research impact a number of stakeholders, but it can be argued that patients are the most affected. The purpose of this review is to summarize the most important pain outcomes to patients and discuss methodological considerations in collecting these data in a clinical trial.Recent FindingsWe found that there are a number of outcomes that are important to patients. The outcomes that consistently appear in the literature include reductions in pain int...
Source: Current Anesthesiology Reports - November 14, 2019 Category: Anesthesiology Source Type: research
Infiltration Between the Popliteal Artery and Capsule of the Knee (iPACK): Essential Anatomy, Technique, and Literature Review
AbstractPurpose of ReviewIn this review, we discuss the essential iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) anatomy, block technique as well as potential complications, contraindications, and relevant literature evaluating the efficacy of the iPACK block.Recent FindingsRecent literature supports the efficacy of the iPACK in controlling pain, improving postoperative physical therapy performance, and decreasing hospital length of stay (LOS). Cadaver studies have demonstrated that injection of dye in the tissue plane between the popliteal artery and the femoral shaft cranial to femoral condyles...
Source: Current Anesthesiology Reports - November 11, 2019 Category: Anesthesiology Source Type: research
