Individualized Data Feedback and Documentation of Depth of Neuromuscular Blockade
AbstractPurpose of ReviewThe purpose of this review is to summarize the importance of monitoring neuromuscular blockade and techniques for the evaluation and documentation of the depth of neuromuscular blockade. It also discusses the most recent societal guidelines for monitoring neuromuscular blockade.Recent FindingsIn 2023, the American Society of Anesthesiologists task force presented practice guidelines that recommended quantitative monitoring at the adductor policies and a recovery of train-of-four ratio to 0.9 prior to extubation. Patients monitored utilizing quantitative monitoring had a lower incidence of residual ...
Source: Current Anesthesiology Reports - October 25, 2023 Category: Anesthesiology Source Type: research
Monitoring Depth of Neuromuscular Blockade and Adequacy of Reversal: Clinical and Pharmacoeconomic Implications
AbstractPurpose of ReviewThis review summarizes current evidence on best practice management of neuromuscular blocking agents (NMBAs). Furthermore, the pharmacoeconomic implications of neuromuscular blockade and reversal to support clinicians and policymakers in ensuring improved patient outcomes and cost-efficient healthcare delivery are discussed.Recent FindingsThere is good evidence supporting a dose-dependent relationship between NMBAs, residual paralysis, and postoperative respiratory complications. The implementation of sugammadex provoked practice changes, but studies are ambiguous on whether the reversal agent redu...
Source: Current Anesthesiology Reports - October 24, 2023 Category: Anesthesiology Source Type: research
Monitoring Depth of Neuromuscular Blockade
AbstractPurpose of ReviewThis review discusses alternative quantitative neuromuscular blockade monitoring methods and advantages and disadvantages of each when used in clinical practice.Recent FindingsQuantitative neuromuscular blockade monitors are not always validated against gold standard mechanomyography before becoming commercially available. Validation is particularly important for electromyography because of the importance of managing electrical noise and distinguishing electromyographic signal from noise. The use of acceleromyography must take into account that baseline train-of-four ratio frequently exceeds 1.0.Su...
Source: Current Anesthesiology Reports - October 3, 2023 Category: Anesthesiology Source Type: research
Postoperative Pain Management in Alzheimer ’s Disease—a Review
AbstractPurpose of ReviewIndividuals with dementia and Alzheimer ’s disease (AD) often receive inadequate analgesia compared to those without cognitive impairments [24-26]. However, undertreated pain contributes more to cognitive decline than analgesics. A comprehensive evaluation of available therapies considering administration modes, dosages, potential inter actions, and side effects is necessary. Our review provides an extensive report on current methods of pain assessment, strategies for dealing with postoperative pain, and the challenges anesthesiologists face, and points out the inadequacy of current literature to...
Source: Current Anesthesiology Reports - September 29, 2023 Category: Anesthesiology Source Type: research
Monitoring the Depth of Neuromuscular Blockade
This article reviews the data behind those recommendations.Recent FindingsWe describe the general failure of most clinical assessments (e.g., head lift, grip strength) to verify full reversal [as defined as a train-of-four (TOF) ratio of > 0.9 using quantitative methods] as well as the insensitivity of information obtained by the use of a PNS, such as the visual assessment of the TOF, tetanus, or double-burst stimulation (DBS) — although we recognize that a PNS can be used to titrate intraoperative dosing of neuromuscular blockin g drugs and under very limited conditions can allow successful reversal with either...
Source: Current Anesthesiology Reports - September 28, 2023 Category: Anesthesiology Source Type: research
Perioperative Pain Management After Posterior Spinal Fusion for Idiopathic Scoliosis
AbstractPurpose of ReviewTo review and summarize current evidence for analgesic modalities after adolescent posterior spinal fusion (PSF) with an emphasis on recent updates in the literature.Recent FindingsOpioid patient-controlled analgesia (PCA) continues to be the cornerstone of most analgesic protocols. The recent introduction of new approaches to opioid-sparing analgesic modalities, including scheduled methadone, new regional anesthetic techniques, and novel multimodal analgesics, continues to be explored for efficacy in adolescent PSF.SummaryWhile many analgesic approaches have limited data, some new techniques have ...
Source: Current Anesthesiology Reports - September 26, 2023 Category: Anesthesiology Source Type: research
Fascial Plane Blocks as Regional Analgesia Techniques for Cardiac Surgeries: a Technical Description and Evidence Update
This article aims to review the anatomy and ultrasound techniques of common interfascial plane blocks used for cardiac surgeries along with the current available evidence for regional analgesia.Recent FindingsThoracic erector spinae plane block (ESPB) has a beneficial role in studies when compared with intravenous pain medications or control groups without blocks for cardiac surgeries. Some retrospective studies showed variable analgesic benefits with ESPB, and a recent meta-analysis did not show promising benefits over thoracic epidural analgesia. Serratus anterior plane block (SAPB) is beneficial with minithoractomy inci...
Source: Current Anesthesiology Reports - September 13, 2023 Category: Anesthesiology Source Type: research
Anaphylactic Responses to Neuromuscular Blockade Drugs and Reversal Drugs
AbstractPurpose of ReviewThis review discusses the incidence of anaphylaxis to neuromuscular blockade drugs (NMBDs), the mechanism and clinical features, as well as theories around sensitisation (including the pholcodine hypothesis), the developing area of anaphylaxis to reversal agents, and testing practices.Recent FindingsThe incidence and characteristics of anaphylaxis to NMBDs have recently been better established by large observational studies. In addition to the well-established IgE-mediated mechanism, new research has highlighted other mechanisms, including the mast cell receptor “MRGPRX2.” Sensitisation through...
Source: Current Anesthesiology Reports - September 9, 2023 Category: Anesthesiology Source Type: research
Neuromuscular Blocking Agents in the Intensive Care Unit
AbstractPurpose of ReviewThe purpose of this review is to recognize common complications associated with the use of neuromuscular blocking agents in critically ill patients.Recent FindingsNeuromuscular blocking agents have been commonly used in the operating room to facilitate endotracheal intubation and improve surgical outcomes. Similarly, neuromuscular blocking agents in the intensive care unit have been frequently used in critically ill patients who require advanced ventilatory and respiratory support. Intensive care unit-acquired weakness, hypoxia, and respiratory adverse events associated with residual neuromuscular ...
Source: Current Anesthesiology Reports - September 1, 2023 Category: Anesthesiology Source Type: research
The Ethics of Big Data and Artificial Intelligence in Perioperative Medicine: Is Unregulated AI Already at the Bedside?
AbstractPurpose of ReviewArtificial Intelligence is permeating perioperative medicine and has real implication for patient outcomes. We discuss the ethics of artificial intelligence and big data in perioperative medicine to bring awareness of how the tools can be harnessed to improve patient outcomes, while being cognizant of ethical considerations as AI tools are changing the practice of perioperative healthcare providers across the world.Recent FindingsThere are concerns of scientific integrity with the increasing availability of language learning models and other AI tools that can fabricate data and images. Unregulated ...
Source: Current Anesthesiology Reports - August 23, 2023 Category: Anesthesiology Source Type: research
The Relationship Between Intraoperative Tissue Oxygenation Monitoring and Postoperative Renal Function After Cardiac Surgery
AbstractPurpose of ReviewCardiac surgery-associated acute kidney injury (CSA-AKI) is a global source of patient morbidity and mortality in the perioperative period. Prior attempts to predict vulnerable or high-risk patients using available data have not coalesced into a predictive model with widespread clinical utility. Emerging technology is allowing for more direct measures of renal oxygen saturation which has demonstrated promising results as a novel predictor of CSA-AKI. In this review, we explore several recent approaches to measuring renal tissue oxygenation intraoperatively, spanning preclinical and clinical trials ...
Source: Current Anesthesiology Reports - August 5, 2023 Category: Anesthesiology Source Type: research
Computer-Assisted IV Anesthesia: Still a Future?
Abstract Purpose of ReviewAutomated control of anesthesia may give the physician time to control hemodynamics and supervise neurological outcomes and thus can provide the patient the safety and quality which until recently was considered a holy grail.Recent FindingsThis field of research is now increasing in every component of general anesthesia (hypnosis, nociception, neuromuscular blockade), and the literature describes some successful algorithms —single or multi-closed-loop controllers. These devices aim to control a predefined target and to continuously titrate anesthetics whatever the patients’ co-morbiditie...
Source: Current Anesthesiology Reports - July 20, 2023 Category: Anesthesiology Source Type: research
Coming Soon to an OR Near You: a Child with a Ventricular Assist Device
This report highlights ongoing trends with respect to types of devices and patients along with adverse effects and updated anticoagulation guidelines.SummaryContinuous flow devices have shown improved outcomes in children compared to pulsatile devices. Research and development goals include miniaturizing the devices and minimizing adverse events. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - July 12, 2023 Category: Anesthesiology Source Type: research
Anesthesia for Triple Endoscopy in Aerodigestive Patients
This article outlines our anesthetic approach and the perioperative considerations taken for each stage of the process. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - July 7, 2023 Category: Anesthesiology Source Type: research
Remimazolam in Pediatric Anesthesia and Sedation
AbstractPurpose of the ReviewThis review summarizes the updated literature on the use of remimazolam in children both as an anesthetic and a sedative agent for minor procedures. We herein present a brief overview of the pharmacokinetics and pharmacodynamics of remimazolam along with available evidence to support its use in children.Recent FindingsSince its FDA approval in 2020 for adults, remimazolam has been used in children, but the literature establishing its safety profile in children is sparse. In this article, we summarize published reports so that readers can make their own judgment on the current value of remimazol...
Source: Current Anesthesiology Reports - July 7, 2023 Category: Anesthesiology Source Type: research
