Nonoperating Room Anesthesia: What Is New? What Is Controversial?
AbstractPurpose of ReviewNonoperating room anesthesia (NORA) represents a diverse and growing subset of anesthetic practice, with new, increasingly complex procedures rapidly developing. This paper serves to highlight key newer procedures and discuss common areas of controversy within the NORA subspecialties.Recent FindingsFeatured new procedures include pulsed field ablation, primary obesity surgery endoluminal (POSE), peroral endoscopic myotomy (POEM), endoscopic lung volume reduction (ELVR), and pulmonary cryospray. Featured controversial topics include outpatient and ambulatory atrial fibrillation ablation, glucagon-li...
Source: Current Anesthesiology Reports - December 20, 2023 Category: Anesthesiology Source Type: research
Current Review of the Use of Intrathecal Morphine for Postoperative Analgesia in Total Joint Arthroplasty
AbstractPurpose of ReviewThe use of neuraxial opioids (NAO) as a method for postoperative analgesia for patients undergoing total joint arthroplasty (TJA) is growing in popularity. Intrathecal morphine (ITM) remains the most commonly used NAO. The purpose of this article is to provide readers with an overview of ITM, as well as a comprehensive review of efficacy, dosing, side effects, complications, and adjuncts of ITM when used for TJA.Recent FindingsRecent randomized control trials and meta-analyses provide comprehensive evidence on the usefulness of ITM for TJA. Many of these publications demonstrate clear favorability ...
Source: Current Anesthesiology Reports - December 20, 2023 Category: Anesthesiology Source Type: research
Goal-Directed Therapy in Cardiogenic Shock: No Magical Recipe
AbstractPurpose of ReviewCardiogenic shock (CS) remains a critical condition associated with a high mortality rate. Early and appropriate management may prevent or reverse multiple organ failure. Various strategies have been proposed to appropriately manage CS, but no goal-directed therapy has yet been validated.Recent FindingsIn this narrative review, we propose a physiological-based goal-directed therapy that relies on both flow and pressure monitoring to adapt the titration of inotropic and vasopressor drugs. Along with addressing the initial trigger, these physiological endpoints should serve as the benchmark for accur...
Source: Current Anesthesiology Reports - December 20, 2023 Category: Anesthesiology Source Type: research
Parenteral Meperidine: a Review of the Pharmacology and Clinical Applications
This article examines historical clinical applications of meperidine in the perioperative setting while reviewing the pharmacology, adverse effects, and special considerations. The purpose of this article is to re-evaluate the literature ultimately to answer the question, “Is there still a role for meperidine in the perioperative setting?” This narrative review was prepared through a comprehensive search strategy of medical literature databases including PubMed, Google Scholar, and Ovid among others using terminology related to meperidine and its known clinical a pplications (i.e., shivering, neuraxial, labor).Recent F...
Source: Current Anesthesiology Reports - December 16, 2023 Category: Anesthesiology Source Type: research
Anesthetic Exposure During Early Childhood and Neurodevelopmental Outcomes: Our Current Understanding
AbstractPurpose of ReviewThe question of anesthetic neurotoxicity emerged two decades ago, but controversy about whether anesthetics cause neurodevelopmental problems in children remains. Interpretation of the published literature is complicated by a paucity of randomized controlled trials and heterogeneity of the published studies. This review summarizes our current understanding and discusses potential sources of study bias and methods to better understand and address issues contributing to bias.Recent FindingsRecent clinical studies of anesthetic neurotoxicity and meta-analyses of the published studies have reported tha...
Source: Current Anesthesiology Reports - December 16, 2023 Category: Anesthesiology Source Type: research
Do Outcomes Differ Between Thoracic Epidurals and Continuous Fascial Plane Blocks in Adults Undergoing Major Abdominal Surgery?
AbstractPurpose of ReviewThe thoracic epidural has historically been regarded as the gold standard for the management of post-operative pain in patients undergoing major abdominal surgery. However, it is not without risk, and there are several circumstances in which it is contraindicated. The advent of ultrasound-guided fascial plane blocks has expanded our options in the provision of post-operative analgesia. This narrative review examines the evidence comparing their use against the thoracic epidural in major open abdominal surgery.Recent FindingsThe most common fascial plane blocks used in comparison to thoracic epidura...
Source: Current Anesthesiology Reports - December 13, 2023 Category: Anesthesiology Source Type: research
Neuraxial Anesthesia in High-Risk Cardiac Patients
AbstractPurpose of ReviewThis review of neuraxial anesthesia in high-risk cardiac patients aims to delineate current best practices and highlight emerging themes in the literature.Recent FindingsPregnancy, especially in the presence of cardiac comorbidities, poses a unique set of challenges for anesthesiologists and obstetricians. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease. For obstetric procedures, recent case reports have demonstrated the safety of neuraxial anest...
Source: Current Anesthesiology Reports - November 30, 2023 Category: Anesthesiology Source Type: research
Predictors of Epidural Depth and the Role of Technology
AbstractEpidural anesthesia and analgesia are commonly used for a number of medical and surgical procedures. Although the blind loss of resistance is usually successful in experienced hands, it can be challenging at times. Imaging technology is increasingly used to assist in the accurate localization of the epidural depth (ED). When compared to the blind loss of resistance technique, ultrasound measurements slightly underestimated; computed tomography slightly overestimated; while MRI depth measurement was more accurate, although it occasionally overestimated the ED. Ultrasound imaging resulted in fewer placement trials an...
Source: Current Anesthesiology Reports - November 24, 2023 Category: Anesthesiology Source Type: research
Perioperative Major Adverse Cardiovascular Events and Acute Kidney Injury: Is Routine Postoperative Monitoring Indicated?
AbstractPurpose of ReviewMajor adverse cardiovascular events (MACE) and acute kidney injury (AKI) are common perioperative complications which are strongly associated with poor patient outcomes. This review aims to provide an update on the clinical relevance of perioperative MACE and AKI and to discuss perioperative management, focusing on the importance and role of postoperative monitoring.Recent FindingsPrevious studies demonstrated that myocardial injury is associated with poor patient outcomes. Recent guidelines recommend troponin measurements for high-risk patients undergoing major noncardiac surgery. Perioperative AK...
Source: Current Anesthesiology Reports - November 24, 2023 Category: Anesthesiology Source Type: research
Chronic Disease Management and Optimization of Functional Status Before Surgery: Does This Improve Long-Term Postoperative Outcomes?
AbstractPurpose of the ReviewPerioperative care is facing many challenges; these include long surgical wait times, an increasing demand for surgery, a more complex perioperative population, and increased health inequalities. As perioperative care providers, we have an opportunity to shape the future of perioperative care and address these challenges by working to improve the health of those presenting for surgery.Recent FindingsThere is equipoise in the literature on the impact of chronic disease management and functional status optimization, but we feel that it is now time to embed these concepts into perioperative care a...
Source: Current Anesthesiology Reports - November 16, 2023 Category: Anesthesiology Source Type: research
Perioperative Opioid Management Strategies: Do They Make a Difference in Long-Term Health Outcomes?
AbstractPurpose of ReviewWith the ongoing opioid epidemic, efforts have been made to limit opioid overprescribing and prevent misuse. This review looks at long-term outcomes of opioid management strategies.Recent FindingsApproaches to opioid management in the perioperative phase include implementation of opioid stewardship programs, use of regional anesthesia techniques, addition of non-opioid analgesics, and adoption of enhanced recovery protocols. While the effects of these strategies on short-term outcomes have been extensively studied and reported, less is known about long-term health outcomes. To date, few studies hav...
Source: Current Anesthesiology Reports - November 13, 2023 Category: Anesthesiology Source Type: research
Perioperative Blood Management Protocols Improve Outcomes: What Does the Future Hold?
AbstractPurpose of ReviewThis manuscript aims to review the current state of perioperative blood management as well as prognosticate future directions for the field.Recent FindingsPerioperative blood management is a broad topic with a core tenet of conserving a patient ’s own blood throughout the perioperative period. This manuscript provides an overview of the recent literature in this area and examines several treatment strategies to mitigate the risk of allogeneic transfusions. Some examples of topics covered include hemoglobin optimization, intraoperative te chniques to minimize blood loss, and postoperative anemia t...
Source: Current Anesthesiology Reports - November 10, 2023 Category: Anesthesiology Source Type: research
Patterns of Stimulation, Site of Monitoring, and Accuracy in Detecting Residual Neuromuscular Blockade
AbstractPurpose of ReviewNeuromuscular blocking agents (NMBAs) are important for general anesthesia because they induce temporary paralysis of skeletal muscles, which facilitates intubation, reduces patient movement during surgery, and improves surgical conditions. However, they require careful dosing and monitoring of their effects to avoid complications such as residual neuromuscular blockade.Recent FindingsUnderstanding patterns of stimulation, site of monitoring, and accuracy in detecting residual neuromuscular blockade is crucial because it helps to ensure that patients recover fully from muscle relaxation induced by ...
Source: Current Anesthesiology Reports - November 9, 2023 Category: Anesthesiology Source Type: research
Where Will Gabapentin ’s Bumpy Road Lead us? A Narrative Review of Pediatric Perioperative Gabapentinoids
AbstractPurpose of ReviewGabapentinoids, including gabapentin and pregabalin, have been commonly administered in the perioperative period since opioid-sparing effects were found in adults in the early 2000s. This review examines the current evidence for and against the perioperative use of gabapentinoids in children and identifies potential future directions for research.Recent FindingsMany factors led to increasing use of gabapentinoids for surgical patients. The national opioid epidemic hastened the move toward the use of multimodal analgesia and early recovery after surgery protocols for both adults and children. Howeve...
Source: Current Anesthesiology Reports - November 7, 2023 Category: Anesthesiology Source Type: research
Physiology of Neuromuscular Transmission and Applied Pharmacology of Muscle Relaxants
AbstractPurpose of ReviewThe purpose of this clinical review is to summarize the physiology of the neuromuscular junction (NMJ) in the normal and denervated state, discuss the pharmacology of the neuromuscular relaxants (NMRs) within and outside the NMJ, and review recent advances in the development of new NMRs and their reversal agents.Recent FindingsRecent studies have delineated the mechanisms of the non-NMJ, anti-inflammatory effects of non-depolarizing NMRs, mediated by the α7 acetylcholine receptors expressed in innate immune cells (e.g., macrophages). Several chlorofumarate molecules (including gantacurium) have be...
Source: Current Anesthesiology Reports - November 6, 2023 Category: Anesthesiology Source Type: research
