Pain Management for Ambulatory Surgery: Current Controversies and Concerns
AbstractPurpose of ReviewAdequate pain control is essential for ensuring optimal outcomes after ambulatory surgery. However, postoperative pain continues to be inadequately treated. This review presents the available evidence regarding strategies for pain management for ambulatory surgery with the aim of developing an optimal procedure-specific multimodal approach.Recent FindingsOptimal analgesic strategy should include preoperative identification of patients at high risk of postoperative pain, patient education, and an opioid-sparing multimodal analgesic technique using non-opioid analgesics such as acetaminophen and non-...
Source: Current Anesthesiology Reports - February 13, 2024 Category: Anesthesiology Source Type: research
Innovative Financing to Scale High-Value Anesthesia Health Services in Health Systems
AbstractPurpose of ReviewAnesthesia health services are an indivisible component of high-value health systems, yet almost half of the countries worldwide do not meet the recommendation of a minimum of 4 anesthesia providers per 100,000 population. As with global health at large, financing is a major factor in the success and sustainability of global anesthesia initiatives. While traditional methods of funding global health projects, such as private donations, governmental or non-governmental funds, and academic grants, remain relevant, novel ways of financing may be necessary to develop and sustain anesthesia services in a...
Source: Current Anesthesiology Reports - February 12, 2024 Category: Anesthesiology Source Type: research
Should Video Laryngoscopy Replace Direct Laryngoscopy as a Primary Intubation Technique?
AbstractPurpose of ReviewWhile direct laryngoscopy has been the standard technique for tracheal intubation, the application of video laryngoscopy has grown over the past two decades. Early evidence established its beneficial role over direct laryngoscopy for difficult intubations.Recent FindingsSummative evidence indicates that video laryngoscopy is superior to direct laryngoscopy for more generalized populations in the operating room. Prior research has questioned the role of video laryngoscopy for tracheal intubation outside of the operating room in emergent situations. More recent evidence has now established video lary...
Source: Current Anesthesiology Reports - February 6, 2024 Category: Anesthesiology Source Type: research
Perioperative Management of the Patient with End-Stage Liver Disease
AbstractPurpose of ReviewEnd-stage liver disease is associated with increased perioperative morbidity and mortality. This narrative review provides a summary of perioperative concerns and management of patients with end-stage liver disease.Recent FindingsModel for end-stage liver disease (MELD) 3.0 is the most updated version of the MELD score which is used as both a prognostic score to prioritize organ allocation and to assess the severity of liver disease. The American Association for the Study of Liver Disease and The American Gastroenterological Association have provided updated guidelines on procedural bleeding and tr...
Source: Current Anesthesiology Reports - February 6, 2024 Category: Anesthesiology Source Type: research
Perioperative Considerations for Patients on Semaglutide
This article provides an update on the perioperative considerations for patients on semaglutide, a glucagon-like peptide-1 receptor agonist with rapidly increasing use in the USA.Recent FindingsSince semaglutide may cause delayed gastric emptying and residual gastric contents, controversies arise on preoperative medication management, adequate preoperative fasting periods, utilization of gastric ultrasound, and rapid sequence induction and intubation to mitigate the risks of regurgitation and pulmonary aspiration of gastric contents during anesthesia care.SummaryWhile semaglutide may cause gastrointestinal symptoms, it has...
Source: Current Anesthesiology Reports - January 31, 2024 Category: Anesthesiology Source Type: research
Early-Goal Directed Therapy for Brain-Injured Patients
AbstractPurpose of ReviewAcute brain injury, whether resulting from trauma, ischemia, or other causes, presents a significant challenge in critical care medicine. The brain ’s vulnerability necessitates a proactive approach to minimize secondary brain injuries that can have profound consequences. Multimodal monitoring of systemic and cerebral variables complements these efforts by providing continuous, objective data on brain physiology and pathophysiology, enabling timely interventions.Recent FindingsRecent advancements have shown that integrating neuromonitoring with systemic variables allows for individualized care, m...
Source: Current Anesthesiology Reports - January 31, 2024 Category: Anesthesiology Source Type: research
Regional Anesthesia with Cryoneurolysis: an Ancient Technique with New Possibilities for Acute Pain
AbstractPurpose of ReviewThis review summarizes the history, mechanism, and current understanding of cryoneurolysis. It discusses the implications for utilizing percutaneous cryoneurolysis for both elective perioperative and traumatic acute pain.Recent FindingsThe goal of cryoneurolysis is Wallerian degeneration with preservation of endoneurium to provide a lattice for axonal regeneration without neuroma formation. Ultrasound guidance has expanded the use of percutaneous cryoneurolysis as an analgesic option in the perioperative period. The quantity of data supporting percutaneous cryoneurolysis in the setting of acute pos...
Source: Current Anesthesiology Reports - January 27, 2024 Category: Anesthesiology Source Type: research
Anesthesia for Living Donors: Ethical and Clinical Implications
AbstractPurpose of ReviewThis paper aims to explore the ethical and clinical implications of anesthesia in living organ donors. It seeks to answer how anesthesiologists can balance the risk to the donor against the potential benefits to the recipient and addresses the ethical complexities of the process.Recent FindingsThe paper reviews the recent advancements and challenges in living donor transplantation, focusing on the ethical responsibilities of anesthesiologists, and the clinical aspects of anesthesia administration in these patients.SummaryThe paper concludes that while living donor organ transplantation presents sig...
Source: Current Anesthesiology Reports - January 25, 2024 Category: Anesthesiology Source Type: research
Perioperative Management of Patients on Buprenorphine: A Literature Review
AbstractPurpose of ReviewThis review summarizes the current practice of perioperative management for patients on long-term buprenorphine (BpN). It aims to elucidate the pharmacological properties of BpN, evaluate the existing literature on perioperative outcomes for patients on BpN, and emphasize the importance of following the current perioperative consensus recommendations when caring for this specific patient population.Recent FindingsFor patients on long-term BpN, the perioperative continuation of their BpN dosage was associated with better postoperative pain control and less opioid consumption. Compared to opioid-agon...
Source: Current Anesthesiology Reports - January 25, 2024 Category: Anesthesiology Source Type: research
Enhanced Recovery After Cesarean Delivery: Improving Patient Outcomes
AbstractPurpose of ReviewThis review summarizes the updated literature on enhanced recovery after cesarean delivery. It provides evidence-based guidance on the components of the most recent recommendations related to enhanced recovery after cesarean delivery.Recent FindingsThe Society for Obstetric Anesthesia and Perinatology, The American College of Obstetricians and Gynecologists, and the Enhanced Recovery after Surgery Society provide updated recommendations related to enhanced recovery after cesarean delivery. Additional studies and systematic reviews have been published and have found implementation of enhanced recove...
Source: Current Anesthesiology Reports - January 3, 2024 Category: Anesthesiology Source Type: research
Postsurgical Recovery and Long-Term Outcomes: What Should We Be Measuring?
AbstractPurpose of ReviewTo determine which perioperative outcomes are most relevant for patients, clinicians and healthcare systems to determine long-term recovery from surgical intervention.Recent FindingsMeasurement of perioperative outcomes is essential for the development and delivery of high-quality, value-based and patient-centered care. Traditionally, outcome measurement has been focused on quantitative outcomes such as mortality and morbidity. Whilst these measurements have significant merit, they may not reflect what is of greatest import to patients whose priorities are often centered around an expeditious retur...
Source: Current Anesthesiology Reports - January 3, 2024 Category: Anesthesiology Source Type: research
Anesthetic Techniques and Long-Term Oncological Outcomes
In this report, we summarize current published evidence on the impact of anesthetics and opioids on cancer progression. We focus our discussion on published human studies with special emphasis on randomized controlled trials. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - January 3, 2024 Category: Anesthesiology Source Type: research
Environmentally Sustainable Anesthesia to Minimize Risks from Climate Change: a Societal Imperative or too Lofty a Goal?
AbstractPurpose of ReviewThis review illustrates how anesthesia contributes to the carbon footprint. It gives practical reasons why anesthesiologists must understand and participate in sustainable anesthesia.Recent FindingsClimate change, with the increasing frequency of natural disasters that have negatively impacted health, has received increasing attention within healthcare systems and anesthesia practices. Education on how to green the operating room (reduce, recycle, reuse, rethink, research) is imperative for all anesthesiologists in order for them to implement these actions. The benefit of single-use disposable equi...
Source: Current Anesthesiology Reports - December 27, 2023 Category: Anesthesiology Source Type: research
Intraoperative Considerations for Rapid Recovery After Ambulatory Surgery: What ’s New and What’s Controversial
AbstractPurposeEnhanced recovery protocols can lead to faster patient recovery after ambulatory surgery. This review article will discuss novel therapies and controversies regarding intraoperative considerations for rapid recovery after ambulatory procedures.Recent FindingsPostoperative nausea and vomiting are frequent in ambulatory surgical patients. New antiemetic drugs (i.e., amisulpride or aprepitant) have been introduced that may have a role in the ambulatory setting. The administration of sugammadex or neostigmine is recommended to prevent residual muscle relaxation. Frail patients may require a different approach an...
Source: Current Anesthesiology Reports - December 23, 2023 Category: Anesthesiology Source Type: research
Long-Term Cognitive Outcomes After Surgery and Anesthesia: What We Find Depends on Where We Look
AbstractPurpose of ReviewTo review how anecdote and narrative medicine, primary cohort studies, epidemiological studies, and the dementia literature can be bridged to understand long-term postoperative cognitive decline.Recent FindingsPrimary cohort studies have measured recoverable declines in memory and executive function after major surgery, but less-appreciated sources also offer critical insights. Anecdote reveals that functionally impactful cognitive decline may persist after physical recovery in some patients despite modern medications and monitoring and that physicians are unprepared to address patients ’ cogniti...
Source: Current Anesthesiology Reports - December 20, 2023 Category: Anesthesiology Source Type: research
