Regional Analgesia and Acute Compartment Syndrome
AbstractPurpose of ReviewThis narrative review discusses the differing opinions regarding whether and when regional analgesia can be utilized to treat injury and surgical pain when there is a high risk for acute compartment syndrome.Recent FindingsThe pathophysiology and objective means for early identification of acute compartment syndrome are reviewed. The mechanism of how regional anesthesia affects nociceptive and ischemia pain is reviewed, along with new proposed theories for why and when it may not block ischemic pain associated with acute compartment syndrome. Implications for a practical approach to regional analge...
Source: Current Anesthesiology Reports - March 11, 2022 Category: Anesthesiology Source Type: research
LVAD Patients in Non-Cardiac Surgery: Implications for Anesthetic Management
AbstractPurpose of ReviewThis review illustrates the challenge of LVAD patient and proposes a complete approach to this patient in case of non-cardiac surgery for the anesthesiologist.Recent FindingsThe introduction of the left ventricular assist device (LVAD) has improved survival rates of patients with end ‐stage heart failure. Improvements in technology together with the results of several trials have led to a widening of indication: initially used as bridge-to-transplant (BTT), nowadays LVAD is implanted also as bridge-to-candidacy (BTC), and more recently as destination therapy (DT). With improve in survival using t...
Source: Current Anesthesiology Reports - March 2, 2022 Category: Anesthesiology Source Type: research
Coagulation Management in Obstetric Anesthesia
AbstractPurpose of ReviewManagement of coagulation in pregnancy requires a multidisciplinary and dynamic approach by obstetric anesthesiologists, obstetricians, and hematologists through the antepartum to the postpartum period. This review highlights recent updates in the management of coagulation in the obstetric patient.Recent FindingsDetection and risk stratification of inherited and acquired coagulopathies in pregnancy such as von Willebrand disease and iatrogenic anticoagulation, respectively, enable nuanced and safe anesthetic management during labor and delivery. In addition, early assessment and detection of coagul...
Source: Current Anesthesiology Reports - February 22, 2022 Category: Anesthesiology Source Type: research
From Theory to Practice: An International Approach to Establishing Prehabilitation Programmes
This article focuses on the following:The importance of prehabilitation in people with cancer and the known and hypothesised benefits.Exploration of the principles that can be used when developing services in the absence of a single accepted model of how these services could be established or configured.Description of approaches and learning in the development and implementation of prehabilitation across three different countries: Canada, the Netherlands and the United Kingdom, based on the authors ’ experiences and perspectives.Recent FindingsPractical tips and suggestions are shared by the authors to assist others when...
Source: Current Anesthesiology Reports - February 18, 2022 Category: Anesthesiology Source Type: research
Physical and Psychological Health Behavior Changes During the COVID-19 Pandemic that May Inform Surgical Prehabilitation: a Narrative Review
AbstractPurpose of ReviewMultimodal prehabilitation aims to improve preoperative health in ways that reduce surgical complications and expedite post-operative recovery. However, the extent to which preoperative health has been affected by the COVID-19 pandemic is unclear and evidence for the mitigating effects of prehabilitation in this context has not been elucidated. The COVID-19 pandemic has forced a rapid reorganization of perioperative pathways. Delayed diagnosis and surgery have caused a backlog of cases awaiting surgery increasing the risk of more complex procedures due to disease progression. Poor fitness and preop...
Source: Current Anesthesiology Reports - February 18, 2022 Category: Anesthesiology Source Type: research
Preoperative Risk Stratification: Identifying Modifiable Risks for Optimization
AbstractPurpose of ReviewThis chapter aims to examine current strategies for risk stratification in the preoperative setting. Risk stratification tools may include commercially available calculators, laboratory assessments, or screening tests. Risk stratification informs the surgical team on the need for preoperative optimization of modifiable risks. Optimization aims to improve clinical, hospital, and patient-centered outcomes across all phases of perioperative care. Preoperative optimization should be a collaborative, multidisciplinary effort that balances the patient ’s needs and values with the timing and urgency of ...
Source: Current Anesthesiology Reports - February 16, 2022 Category: Anesthesiology Source Type: research
Psychological Interventions Prior to Cancer Surgery: a Review of Reviews
AbstractPurpose of ReviewPatients with cancer who have high levels of psychological distress have poor treatment compliance and worse outcomes. This “review of reviews” provides a narrative synthesis of the impact of psychological prehabilitation interventions on individuals awaiting cancer surgery.Recent FindingsTwenty reviews of prehabilitation with psychological interventions were identified. There is a trend towards improved psychological outcomes following intervention, particularly when psychologist-led. However, there was considerable heterogeneity within interventions, outcome measures, and timing of assessment...
Source: Current Anesthesiology Reports - January 31, 2022 Category: Anesthesiology Source Type: research
Postoperative Delirium Prevention and Novel Cognitive Therapy Interventions
AbstractPurpose of ReviewThis review briefly describes our current understanding of postoperative delirium and examines prevention strategies studied over the past 10 years. It also explores the role of computerized cognitive training and its potential use in the perioperative setting to prevent postoperative delirium.Recent FindingsComputerized cognitive training is based on neuroplasticity theory and holds promise for improving cognitive function across a wide range of patient populations. Applying this technology in the perioperative setting is feasible in small cohorts, and prehabilitation with cognitive therapy before...
Source: Current Anesthesiology Reports - January 29, 2022 Category: Anesthesiology Source Type: research
Direct Admission to the Operating Room for Severe Trauma
AbstractPurpose of ReviewThis review presents the historical and current evolvement of direct to operating room (DTOR) along with evidence from various trauma centers, both civilian and military. It aims to provide guidance on identifying patients for whom bypassing the emergency department (ED) and proceeding DTOR would be advantageous for survival and reducing morbidity.Recent FindingsRecent studies have suggested that simply bypassing the ED with patients requiring surgical intervention shortens the time to definitive resuscitation and bleeding control, in addition to reducing mortality. DTOR protocols are evolving with...
Source: Current Anesthesiology Reports - January 26, 2022 Category: Anesthesiology Source Type: research
Thrombin Generation in Trauma Patients: How Do we Navigate Through Scylla and Charybdis?
AbstractPurpose of Review
Coagulopathy is a complex pathological condition manifested through the insufficient or excessive tendency to form blood thrombi, which can be caused by trauma and surgery. A promising strategy to mitigate coagulopathy is the balanced restoration of the generation of thrombin — the main enzyme in the blood-coagulation system. We review studies focusing on thrombin, traumatic coagulopathy, and hemostatic balance — a concept aimed to avoid abnormally weak or excessively strong coagulation responses.Recent FindingsThrombin generation is impacted by coagulopathic conditions described by complex...
Source: Current Anesthesiology Reports - January 24, 2022 Category: Anesthesiology Source Type: research
Nutrition Status Optimization for Improved Perioperative Outcomes
AbstractPurpose of ReviewPreoperative malnutrition is common in surgical patients and occurs in up to two-in-three major gastrointestinal and cancer surgery patients. Perioperative malnutrition is well-known to be associated with adverse clinical outcomes following major surgery. Yet, malnutrition is seldom screened for before surgery worldwide. This worldwide “silent epidemic” of perioperative malnutrition could easily be addressed as part of routine preoperative optimization. This review addresses the critical role of nutrition therapy in perioperative optimization to improve surgical outcomes. It describes recent ev...
Source: Current Anesthesiology Reports - January 22, 2022 Category: Anesthesiology Source Type: research
Point-of-Care Ultrasound for the Trauma Anesthesiologist
AbstractPurpose of ReviewWith advances in technology and availability of handheld ultrasound probes, studies are focusing on the perioperative care of patients, but a limited number specifically on trauma patients. This review highlights recent findings from studies using point of care ultrasound (POCUS) to improve the care of trauma patients.Recent FindingsMajor findings include the use of POCUS to assess volume status of trauma patients upon arrival to measure the major vasculature. Additionally, several studies have advanced the use of POCUS to identify pneumothorax in trauma patients. Finally, the ASA POCUS certificati...
Source: Current Anesthesiology Reports - January 20, 2022 Category: Anesthesiology Source Type: research
Hematinic and Iron Optimization in Peri-operative Anemia and Iron Deficiency
This article explores the current understanding of perioperative anemia and iron deficiency with reference to definition, diagnosis, and treatment.Recent FindingsIron deficiency is the most common cause of anemia. It can arise from reduced iron intake, poor absorption, or excess iron loss. Inflammation throughout the preoperative period can drive iron sequestration, leading to a functional deficiency of iron and the development of what was referred to until recently as the “anemia of chronic disease.” Current best practice guidance supports the routine administration of preoperative intravenous iron to treat anemia des...
Source: Current Anesthesiology Reports - January 19, 2022 Category: Anesthesiology Source Type: research
Trauma and the Anesthesiologist: an International Perspective
AbstractPurpose of ReviewThis review highlights the roles and responsibilities of anesthesiologists in the management of critically ill trauma patients in different countries around the world. It provides a summary of the scope of practice of different branches of anesthesiology that are involved in the resuscitation of trauma patients.Recent FindingsThe reduced indication for operative intervention in trauma along with the increasing role for anesthesia in managing trauma patients outside the operating room has created a demand for trauma acute care anesthesiologists. The leading obstacle to more prevalent offsite trauma ...
Source: Current Anesthesiology Reports - January 19, 2022 Category: Anesthesiology Source Type: research
Perioperative Guidelines on Antiplatelet and Anticoagulant Agents: 2022 Update
AbstractPurpose of ReviewMultiple guidelines and recommendations have been written to address the perioperative management of antiplatelet and anticoagulant drugs. In this review, we evaluated the recent guidelines in non-cardiac, cardiac, and regional anesthesia. Furthermore, we focused on unresolved problems and novel approaches for optimized perioperative management.Recent FindingsVitamin K antagonists should be stopped 3 to 5 days before surgery. Preoperative laboratory testing is recommended. Bridging therapy does not decrease the perioperative thromboembolic risk and might increase perioperative bleeding risk. In pat...
Source: Current Anesthesiology Reports - January 19, 2022 Category: Anesthesiology Source Type: research
