The Use of Whole Blood Transfusion in Trauma
AbstractPurpose of ReviewThis review illustrates the current benefits, limitations, ongoing research, and future paths for Low Titer O Whole Blood compared to Component Therapy in massive transfusion for trauma patients.Recent FindingsMany studies show that compared to Component Therapy, Low Titer O Whole Blood transfusion is associated with better patient outcomes and simplified transfusion logistics among others. There are, however, issues with cost, supply/demand and handling of Whole Blood that limit its use, but experience in the military setting has shown that these limitations can be easily overcome.SummaryThe use o...
Source: Current Anesthesiology Reports - January 17, 2022 Category: Anesthesiology Source Type: research
Recommendations for Mechanical Ventilation During General Anesthesia for Trauma Surgery
AbstractPurpose of ReviewMechanical ventilation is an essential part of anesthesia for trauma surgery, but there are few recommendations for intraoperative ventilator management. This review examines the limited evidence for intraoperative ventilator practices during trauma surgeryRecent FindingsMost recommendations for surgical ventilator management are derived from ICU guidelines, but trauma surgery includes considerations not always present in the ICU. During trauma surgery, normoxia or mild hypoxia should be maintained. Permissive hypercapnia may be beneficial in the absence of metabolic acidosis, but priority should b...
Source: Current Anesthesiology Reports - January 15, 2022 Category: Anesthesiology Source Type: research
Considerations for the Older Trauma Patient
AbstractPurpose of ReviewThe number of older adults suffering major trauma has increased dramatically. This review provides an update on significant areas of research undertaken in recent years to improve care of this complex and challenging patient group.Recent Findings.Rates of undertriage remain high in geriatric trauma with detrimental impact on patient outcomes. Current pre-hospital and hospital-based triage systems require modification. Co-management of patients with specialist geriatric teams can improve clinical outcome but the best model of care and method of implementation is deliberated. Frailty is perhaps more ...
Source: Current Anesthesiology Reports - January 14, 2022 Category: Anesthesiology Source Type: research
Is the Integration of Prehabilitation into Routine Clinical Practice Financially Viable? A Financial Projection Analysis
This article extends previous research-based economic analyses with financial projections of the costs, cost-savings, and cost-benefit of clinical prehabilitation. To accomplish this, we used (i) projected prehabilitation program costs; (ii) surgical morbidity rates based on data from the American College of Surgeons, National Surgical Quality Improvement Program (NSQIP); (iii) the median cost of surgical morbidity; and (iv) the projected reduction in surgical morbidity by prehabilitation.Recent FindingsUsing the best available evidence for our calculation parameters, we project a net positive cost-benefit of clinically in...
Source: Current Anesthesiology Reports - January 10, 2022 Category: Anesthesiology Source Type: research
The Use of Tranexamic Acid in Trauma
This study reviews the role of TXA in trauma patients and the potential risks and benefits TXA administration may have in this patient population. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - January 6, 2022 Category: Anesthesiology Source Type: research
Anesthetic Considerations for the Trauma Patient with Obesity
This article aims to review the specific challenges anesthesiologists may face when caring for trauma patients with obesity and provide current anesthetic strategies to treat injuries and reduce complications.Recent FindingsThe concept of the cushion effect and obesity paradox is controversial. While some studies state that obesity may be protective in the setting of penetrating or blunt trauma, other studies find that obesity increases the risk of complications, perhaps due to the increased incidence of associated comorbidities in this population.SummaryTrauma is one of the leading causes of death worldwide. As the preval...
Source: Current Anesthesiology Reports - January 4, 2022 Category: Anesthesiology Source Type: research
Care of the Patient with Epidermolysis Bullosa
AbstractPurpose of ReviewThis review highlights advances in care of patients with severe epidermolysis bullosa (EB) that impact the anesthesiologist. Topics covered include EB molecular genetics, preoperative assessment, intra- and postoperative anesthetic care. Related topics include advances in common procedures performed on EB patients and new clinical practice guidelines.Recent FindingsThe latest EB nomenclature has largely eliminated eponyms. Molecular classification has revealed direct links to cardiomyopathy in several subtypes. Other molecular/genetic links to phenotypic associations such as muscular dystrophy and ...
Source: Current Anesthesiology Reports - January 4, 2022 Category: Anesthesiology Source Type: research
Anesthesia for Long QT Syndrome
AbstractPurpose of ReviewThis review article seeks to discuss the salient information about the known genetic variants associated with congenital long QT syndrome (LQTS) and describe the current anesthetic considerations.Recent FindingsLQTS describes a heterogeneous group of patients with varying genetic mutations that cause an increased risk of torsade de pointe and sudden death. Research continues to identify more genetic mutations associated with LQTS subtypes. Publications of clinical experience with LQTS patients under general anesthesia provide new insights on the risk of medication inducing arrhythmias in these pati...
Source: Current Anesthesiology Reports - December 1, 2021 Category: Anesthesiology Source Type: research
Respiratory Prehabilitation for the Prevention of Postoperative Pulmonary Complications after Major Surgery
AbstractPurpose of ReviewDespite modern advances in perioperative medicine, postoperative pulmonary complications (PPCs) remain a significant problem. This paper reviews the current evidence for respiratory prehabilitation to prevent PPCs in major surgical populations.Recent FindingsA large multicentre international 2018 trial conducted within a modern perioperative framework confirmed previous findings that a physiotherapy-led education and breathing exercise training session delivered in preadmission clinics is a highly cost-effective method to significantly reduce PPC incidence. A 2020 meta-analysis of ten small clinica...
Source: Current Anesthesiology Reports - December 1, 2021 Category: Anesthesiology Source Type: research
The Role of Perioperative Shared Decision Making: When Risk Is Non-modifiable
AbstractPurpose of ReviewThis review describes the need for and yet the challenges inherent in operationalising shared decision making (SDM) in the perioperative setting. A novel approach to the role of SDM in preparing for high-risk surgery is described as well as a pragmatic outline of the individual components that make up this process.Recent FindingsSignificant heterogeneity exists in the literature examining perioperative SDM. Despite the reported benefits, SDM is not being consistently delivered to surgical cohorts. This is primarily related to difficulties in defining and measuring both SDM and associated outcomes p...
Source: Current Anesthesiology Reports - November 29, 2021 Category: Anesthesiology Source Type: research
The Role of Perioperative Shared Decision-making: When Risk Is Non-modifiable
AbstractPurpose of ReviewThis review describes the need for and yet the challenges inherent in operationalising shared decision making (SDM) in the perioperative setting. A novel approach to the role of SDM in preparing for high-risk surgery is described as well as a pragmatic outline of the individual components that make up this process.Recent FindingsSignificant heterogeneity exists in the literature examining perioperative SDM. Despite the reported benefits, SDM is not being consistently delivered to surgical cohorts. This is primarily related to difficulties in defining and measuring both SDM and associated outcomes p...
Source: Current Anesthesiology Reports - November 29, 2021 Category: Anesthesiology Source Type: research
Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review
AbstractPurpose of ReviewThe aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes.Recent FindingsPreoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote retur...
Source: Current Anesthesiology Reports - November 25, 2021 Category: Anesthesiology Source Type: research
Cardiopulmonary Exercise Testing and Other Tests of Functional Capacity
AbstractPurpose of ReviewAssessment of functional capacity is a cornerstone of preoperative risk assessment. While subjective clinician assessment of functional capacity is poorly predictive of postoperative outcomes, other objective functional assessment measures may provide more useful information.Recent FindingsCardiopulmonary exercise testing (CPET) is generally accepted as the gold standard for functional capacity assessment. However, CPET is resource-intensive and not universally available. Simpler objective tests of functional capacity such as the Duke Activity Status Index (DASI) and the 6-min walk test (6MWT) are ...
Source: Current Anesthesiology Reports - November 20, 2021 Category: Anesthesiology Source Type: research
Coagulation and Aging: Implications for the Anesthesiologist
AbstractPurpose of ReviewThis narrative review focuses on aging-related modifications in coagulation resulting in increased thromboembolic and hemorrhagic risk of the elderly. We further discuss the current evidence and emerging data relating the perioperative treatment of elderly patients with antithrombotic therapy.Recent FindingsRelevant changes in all elements of the Virchow ’s triad can be found with aging. Increased blood stasis due to immobility, progressive endothelial dysfunction with altered microcirculation, elevated concentrations of several coagulation factors, and increased platelet reactivity all lead to a...
Source: Current Anesthesiology Reports - November 19, 2021 Category: Anesthesiology Source Type: research
Neurological Aging and Pharmacological Management of Geriatric Patients
AbstractPurpose of ReviewThis review will focus on changes in nervous system with aging, alteration in neuro-connectivity with aging, changes in dosing of anesthetic drugs with aging, and current practice patterns of anesthetic drug dosing in the elderly patients.Recent FindingsNeuro-connectivity continues to evolve throughout the life span. After the age of 40 years, functional connectivity becomes less segregated and specific. Evaluation of current practice patterns suggest that practitioners are liberal in administering anesthetics in the elderly patients and frequently exceed the recommended dose range.SummaryFunctiona...
Source: Current Anesthesiology Reports - November 11, 2021 Category: Anesthesiology Source Type: research
