Has the future arrived? Liposomal bupivacaine versus perineural catheters and additives for interscalene brachial plexus block
Purpose of review Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself. Recent findings Perineural infusion of local anesthetics with interscalene catheters provides superior pain relief with reduction of postoperative op...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Wrong-site nerve blocks: evidence-review and prevention strategies
Purpose of review There has been increasing attention to wrong site medical procedures over the last 20 years. This review aims to provide a summary of the current understanding and recommendations for the prevention of wrong-site nerve blocks (WSNB). Recent findings Various procedural, patient, practitioner, and organizational factors have been associated with the risk of WSNB. Recent findings have suggested that the use of a checklist is likely to reduce the incidence of WSNB. However, despite the widespread use of preprocedural checklists, WSNB continue to occur at significant frequency. This may be due to the inab...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Current understanding of the fascial plane blocks for analgesia of the chest wall: techniques and indications update for 2020
Purpose of review Thoracic myofascial plane blocks have gained popularity because of their ease of performance and relative safety. This review highlights current research demonstrating the efficacy of these blocks for specific surgical procedures and provides a brief description of how these techniques are performed. Recent findings Fascial plane blocks of the thorax and chest wall have been shown to be beneficial in providing perioperative analgesia for a variety of surgical procedures. Studies discussed in this review compare thoracic fascial plane blocks to systemic analgesia alone, contrast these novel methods of...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic
The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise. Recent findings In the last 18 months, study findings on various diaphragm-sparing regional anesthesia techniques have demonstrated comparable block analgesic effectivity with a variable extent of phrenic nerve paralysis. The impact of hemi-diaphragmatic function impairment on clinical outcomes is yet to be established. Summary Existing diaphragm...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Education and training in ultrasound-guided regional anaesthesia and pain medicine
Purpose of review Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years. Recent findings Twenty-two articles were identified, investigating nine out of the 13 top-ranked research topics in education and training in regional anaesthesia. Research topics addressed by these articles included prerotation simulation, deliberate practice combined with formative assessment tools, validation of assessment tool...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Postoperative delirium: why, what, and how to confront it at your institution
Purpose of review The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions. Recent findings There are few areas of consensus, backed by strong expe...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Interventions to improve perioperative neurologic outcomes
Purpose of review Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common perioperative neurologic complications. We will also discuss strategies to help prevent and mitigate these complications for our patients. Recent findings There are several strategies the anesthesiologist can undertake to prevent or treat conditions, such as perioperative neurocognitive disorders, spinal cord ischemia, perioperative stroke, and postoperative visual loss. Summary A thorough understanding of threats to patients’ neurol...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Prospects of molecular hydrogen in perioperative neuroprotection from basic research to clinical application
Purpose of review The current systematic review summarizes recent, basic clinical achievements regarding the neuroprotective effects of molecular hydrogen in distinct central nervous system conditions. Recent findings Perioperative neuroprotection remains a major topic of clinical anesthesia. Various gaseous molecules have previously been explored as a feasible therapeutic option in neurological disorders. Among them, molecular hydrogen, which has emerged as a novel and potential therapy for perioperative neuroprotection, has received much attention. Summary Fundamental and clinical evidence supports the antioxidan...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Cognitive declines after perioperative covert stroke: Recent advances and perspectives
Purpose of review With the aging of the population, there are increasing number of aged patients who require surgical interventions. Perioperative covert stroke is emerging as an important health threat and social burden that could affect patients’ long-term neurological outcomes. Recent findings Recent findings of the association between perioperative covert stroke with long-term cognitive declines of surgical patients highlighted the significance of the silent cognitive function killer—perioperative covert stroke. Considering the devastating long-term consequence of the asymptomatic covert stroke, early ...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Intraoperative hypotension and neurological outcomes
Purpose of review Intraoperative hypotension (IOH) may render patients at a risk of cerebral hypoperfusion with decreasing cerebral blood flow (CBF), and lead to postoperative neurological injury. On the basis of the literature in recent years, this review attempts to refine the definition of IOH and evaluate its impact on neurological outcomes. Recent findings Although both absolute and relative blood pressure (BP) thresholds, with or without a cumulative period, have been used in collective clinical studies, no definitive threshold of IOH has been established for neurological complications, including perioperative s...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Anesthesia and the brain after concussion
Purpose of review To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. Recent findings Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be ...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Ketamine: a versatile tool for anesthesia and analgesia
Purpose of review Ketamine has been used for decades for a variety of indications. Beyond the historical benefits and effects of ketamine, newer developments have occurred worthy of an update. This review will discuss common uses and indications for ketamine in the perioperative setting, as well as highlight newer indications in recent years. Recent findings Multiple studies have examined the use of ketamine in a variety of environments, as ketamine has become more popular in emergency rooms and ICUs. Ketamine may be particularly beneficial in management of burn patients, who often require multiple procedures over the...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Double standard: why electrocardiogram is standard care while electroencephalogram is not?
Purpose of review Major adverse cardiovascular and cerebrovascular events (MACCE) significantly affect the surgical outcomes. Electrocardiogram (ECG) has been a standard intraoperative monitor for 30 years. Electroencephalogram (EEG) can provide valuable information about the anesthetized state and guide anesthesia management during surgery. Whether EEG should be a standard intraoperative monitor is discussed in this review. Recent findings Deep anesthesia has been associated with postoperative delirium, especially in elderly patients. Intraoperative EEG monitoring has been demonstrated to reduce total anesthesia drug...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?
Purpose of review Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment? Recent findings There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although musc...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Editorial introduction
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Maternal morbidity: how to reduce it
Purpose of review Internationally there has been increased interest in maternal morbidity; both as a strategy to reduce maternal deaths and also because of the significant impact on a woman's life as a result of suffering from maternal morbidity. The present review will evaluate the current knowledge of, and strategies to reduce maternal morbidity. Recent findings The study of maternal morbidity and how to reduce it has been hampered for many years by the lack of a standard approach to measurement and evaluation. The World Health Organization has attempted to standardize the approach to maternal morbidity with the dev...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: SPECIAL COMMENTARY Source Type: research

Intubation outside of the operating room: new challenges and opportunities in COVID-19 era
Purpose of review Airway management in patients outside the operating room is associated with increased difficulties and risks, and the setting of the COVID-19 global pandemic adds another layer of complexity. Therefore, endotracheal intubation (ETT) of a patient who is presumptive COVID-19 or COVID-19 positive presents an additional challenge to an anesthesiologist. The aim of this review is to summarize the important principles of airway management outside of the operating room during the COVID-19 pandemic. Recent findings Several professional societies have formulated guidelines on airway management COVID-19 suspec...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Recent advances in nonoperating room anesthesia for cardiac procedures
Purpose of review The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there. Recent findings Recent literature indicates that many complicate...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anesthesia for patients with serious comorbidities
Purpose of review To provide aids to deal with increasing amount of several comorbidities in nonoperating room anesthesia (NORA). Recent findings New indexes for assessment of comorbidities are described and guidelines for the care of patients with obesity, obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), diabetes and COVID19 in NORA summarized. Summary In addition to ASA classification, such instruments as Charlson Comorbidity Index, Frailty Index, Surgical Complexity Score and Revised Cardiac Risk could supplement the prospective assessment of the risk of comorbidities. Using institutional p...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anaesthesia for elderly patients
Purpose of review The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required. Recent findings Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging,...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anesthesia for children
Purpose of review Nonoperating room anesthesia (NORA) cases performed in pediatric patients have increased over the past decade. It is imperative for the anesthesia provider to be familiar with the nuances of this environment and the myriad of cases to ensure delivery of safe and efficient care. Recent findings Though case volume has increased, sedative agents have largely remained unchanged. NORA sites must meet the same operating room standards and expectations of anesthesia established by the American Society of Anesthesiologists. Despite the increasing NORA volume and efforts to instill a similar culture of safety...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

The anesthesiologist and global climate change: an ethical obligation to act
Purpose of review Pollution and global warming/climate change contribute to one-quarter of all deaths worldwide. Global healthcare as a whole is the world's fifth largest emitter of greenhouse gases, and anesthetic gases, intravenous agents and supplies contribute significantly to the overall problem. It is the ethical obligation of all anesthesiologists to minimize the harmful impact of anesthesia practice on environmental sustainability. Recent findings Focused programs encouraging judicious selection of the use of anesthetic gas agents has been shown to reduce CO2 equivalent emissions by 64%, with significant cost ...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Risk stratification in patients undergoing nonoperating room anesthesia
Purpose of review A growing numerical and complexity of patients requiring nonoperating room anesthesia (NORA) necessitates a multidisciplinary approach of a highly experienced team in a highly technological setting of the cathlab or radiology suite. These requirements are even more magnified in the context of the coronavirus disease 2019 (COVID-19) pandemic. Recent findings This review describes the aspects of risk stratification both in adults and children with respect to patient morphology, airway management, cardiorespiratory function and finally future developments, which could beneficially interfere with imminen...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Interventional radiology for the obstetric patient
Purpose of review To discuss the recent results of the use of interventional radiology modalities treating postpartum hemorrhage (PPH). Recent findings PPH still is a leading cause of maternal morbidity and mortality. An important risk factor for the development of PPH is the placenta accreta spectrum. In patients with placenta accreta, we can use prophylactic balloon occlusion of the common or internal iliac artery or abdominal aorta to prevent PPH. Balloon occlusion of the abdominal aorta seems to ensure better results than balloon occlusion of the iliac artery in terms of blood loss, transfusion rate and hysterecto...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Is there a place for regional anesthesia in nonoperating room anesthesia?
Purpose of review General anesthesia and monitored anesthesia care (MAC) are the most widely used techniques in nonoperating room anesthesia (NORA). However, regional anesthesia is slowly finding viable applications in this field. This review aims at providing an update on the current practice of regional anesthesia techniques outside of the operating theatre. Recent findings Some anesthetic departments have implemented the use of regional anesthesia in novel applications outside of the operating room. In most cases, it remains an adjunct to general anesthesia but is sometimes used as the sole anesthetic technique. Th...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2
Purpose of review With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the ...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Terminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era
Purpose of review Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery. Recent findings We highlight key recent studies from the perioperative and informatics literature, placing each in the context of how it has, or how it may conceivably be applied to, improved NORA care. Summary There is significant opportunity for anaesth...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Standard procedures in nonoperating room anesthesia
This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. Recent findings Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced ri...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Procedural sedation outside the operating room
Purpose of review The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA. Recent findings Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, r...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

What we can learn from nonoperating room anesthesia registries: analysis of clinical outcomes and closed claims data
Conclusions from the current literature emphasize the importance of complying with monitoring standards and having well prepared providers to improve patient outcomes in nonoperating room locations. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anesthesia in different parts of the world
Purpose of review Advances in early diagnosis and treatment of diseases using minimally invasive procedures has led to an increase in the number of cases in locations outside the operating room. This surge created the need for anesthesia services to expand to these areas to provide well tolerated and favorable procedural conditions. The present review describes nonoperating room anesthesia patterns in different parts of the world. Recent findings Nonoperating room anesthesia has grown exponentially over the last years. Patients scheduled in these areas are sicker and older compared to the operating room patients. Anes...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Editorial: What will nonoperating room anesthesia look like in the postcoronavirus disease 2019 era?
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Opioid free anesthesia: feasible?
Purpose of review The present review aims to address the feasibility of opioid free anesthesia (OFA). The use of opioids to provide adequate perioperative pain management has been a central practice of anesthesia, and only recently has been challenged. Understanding the goals and challenges of OFA is essential as the approach to intraoperative analgesia and postsurgical management of pain has shifted in response to the opioid epidemic in the United States. Recent findings OFA is an opioid sparing technique, which focuses on multimodal or balanced analgesia, relying on nonopioid adjuncts and regional anesthesia. Enhanc...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Remimazolam for anaesthesia or sedation
Purpose of review Anaesthesia and sedation are ubiquitous in contemporary medical practice. Developments in anaesthetic pharmacology are targeted on reducing physiological disturbance whilst maintaining or improving titrateability, recovery profile and patient experience. Remimazolam is a new short-acting benzodiazepine in the final stages of clinical development. Recent findings Clinical experience with remimazolam comprises volunteer studies and a limited number of clinical investigations. In addition, laboratory investigations explore the implications of its ‘soft drug’ pharmacology. Summary Remimazo...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Soft drugs in anesthesia: remifentanil as prototype to modern anesthetic drug development
Purpose of review The unique demands of modern anesthesia practice require that medications be effective, well tolerated, and efficient. These attributes are increasingly achieved with the soft drug approach, wherein novel active compounds are specifically designed to be susceptible to rapid biotransformation to inactive metabolites. The present review summarizes the historical background and recent trends in soft drug development in anesthesiology. Recent findings Soft drug development programs for propranadid, etomidate, and benzodiazepine analogues have been undertaken in recent years. Although all three drugs adva...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

The future of neuromuscular blocking agents
Purpose of review The present review provides a summary of the literature on recent development of new neuromuscular blocking agents and presents clinically well established and new reversal agents. Recent findings Anesthesiologists are still waiting for the ideal neuromuscular blocking agent with a succinylcholine-like rapid onset and offset without side effects. Recent drug development led to a new series of neuromuscular compounds, called the chlorofumarates such as gantacurium, CW002, and CW011. These drugs have a promising pharmacodynamic profile; importantly, they can rapidly be reversed by L-cysteine adduction ...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

The role of pharmacokinetics and pharmacodynamics in clinical anaesthesia practice
Purpose of review Growing concerns about the environmental effects of volatile anaesthetics are likely to lead to increased use of intravenous anaesthetic drugs. Pharmacokinetic/pharmacodynamic (PKPD) models can increase the accuracy of intravenous drug titration, especially in populations that differ from the ‘average.’ However, with a growing number of PKPD models, and other technology available to date, it can be hard to see the wood for the trees. This review attempts to guide the reader through the PKPD jungle. Recent findings General purpose PKPD models for propofol and remifentanil designed to apply...
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Editorial: COVID-19 pandemic: urgent need for action in care homes and senior citizens’ homes from a medical-ethics perspective
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 30, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Pre and postoperative risk management: the role of scores and biomarkers
Purpose of review The goal of risk prediction is to identify high-risk patients who will benefit from further preoperative evaluation. Clinical scores and biomarkers are very well established tools for risk prediction but their accuracy remains a controversial issue. Recent findings Current guidelines recommend one of the risk tools for preoperative cardiac risk assessment: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) calculator or Revised Cardiac Risk Index. Although not as easy to use as risk scores, risk models are more accurate and can predict individual patient risk more prec...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Perioperative Precision Medicine: Where Are We in 2020?
Purpose of review The present review examines how targeted approaches to care, based on individual variability in patient characteristics, could be applied in the perioperative setting. Such an approach would enhance individualized risk assessment and allow for targeted preventive and therapeutic decision-making in patients at increased risk for adverse perioperative events. Recent findings Prior and current studies highlight valuable lessons on how future investigations attempting to link specific patient-related characteristics or treatment modalities with outcomes and adverse drug responses might be designed in the...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Perioperative management of antiplatelet therapy in noncardiac surgery
Purpose of review Perioperative management of antiplatelet agents (APAs) in the setting of noncardiac surgery is a controversial topic of balancing bleeding versus thrombotic risks. Recent findings Recent data do not support a clear association between continuation or discontinuation of APAs and rates of ischemic events, bleeding complications, and mortality up to 6 months after surgery. Clinical factors, such as indication and urgency of the operation, time since stent placement, invasiveness of the procedure, preoperative cardiac optimization, underlying functional status, as well as perioperative control of supply&...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Perioperative anaphylaxis: diagnostic challenges and management
Purpose of review Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from recent guidelines on the acute management of life-threatening anaphylaxis are presented. Recent findings Anaesthetists play a key role in investigating perioperative hypersensitivity reactions. During a suspected perioperative hypersensitivity event, a serum tryptase level should be measured to help with subsequent allergy investigation. Moreover, anaesthetists can ensure...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Anesthesia teams managing pacemakers and ICDs for the perioperative period: enhanced patient safety and improved workflows
Purpose of review There have been both technological and philosophical advances over the last decade regarding pacemakers and implanted cardioverter defibrillators (ICDs). Collectively, these devices are currently referred to as cardiac implantable electronic devices (CIEDs). Technological advances include the introduction of leadless pacemakers, subcutaneous defibrillators and cardiac event recorders, enhancements regarding compatibility of CIEDs for MRI scanning, the ability to interrogate devices remotely, and improved programming modes that preserve battery life. Philosophical advances have been mainly in the area of...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Preoperative considerations for Jehovah's Witness patients: a clinical guide
Purpose of review Jehovah's Witnesses have religious beliefs that preclude transfusion of blood products and certain medical interventions. This presents a unique dilemma and ethical challenge to healthcare providers, especially in a surgical setting. Recent findings The growing number of followers of this faith warrants a deeper look at the ethical, legal, and clinical implications of their beliefs. Advances in patient blood management now allow timely optimization before surgery. Summary Anticipating the challenges associated with managing and optimizing patients who refuse blood products allows for more favorabl...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Updates in periprocedural management of direct oral anticoagulants
Purpose of review As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs). Recent findings DOACs have favorable pharmacokinetics including quick onset of action and short half-lives. Periprocedural management of DOACs relies heavily on drug half-life as well as procedural risk of bleeding. Other than a few exceptions, the American College of Cardiologists generally recommends complete clearanc...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Perioperative β-blocker use: what is new in 2020?
Purpose of review Although the indications for β-blockers in the management of patients with congestive heart failure and myocardial infarction are well established, the use of β-blockers in the perioperative setting remains controversial. Recent findings Since 2008 PeriOperative ISchemic Evaluation Trial, there have been numerous studies suggesting that perioperative β-blockers are associated with adverse events such as hypotension, bradycardia, increased mortality, and stroke. Summary In this article, we review the most recent evidence to suggest an approach to perioperative β-blocker use tail...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Prehabilitation: the anesthesiologist's role and what is the evidence?
Purpose of review Surgery poses major threats to functional independence. Prehabilitation is a preoperative conditioning intervention that aims to prevent or attenuate surgery-related functional decline and its consequences. The present review is to summarize most recent evidence on the effectiveness of prehabilitation on key topics in cancer care, such as perioperative functional capacity, surgical and oncologic outcomes. Recent findings Recent studies predominantly focus on functional outcomes, demonstrating a positive effect of prehabilitation on perioperative physical fitness. Summary Prehabilitation prevents f...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana Oprea Source Type: research

Augmented intelligence in pediatric anesthesia and pediatric critical care
This article briefly explores recent work in the areas of automation, artificial intelligence and outcome prediction models in pediatric anesthesia and pediatric critical care. Recent findings Recent years have yielded little published research into pediatric physiological closed loop control (a type of automation) beyond studies focused on glycemic control for type 1 diabetes. However, there has been a greater range of research in augmented decision-making, leveraging artificial intelligence and machine-learning techniques, in particular, for pediatric ICU outcome prediction. Summary Most studies focusing on artific...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

Practice horizons in pediatric nonoperating room anesthesia
Purpose of review Anesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients. Recent findings Recent reports from large patient databases have afforded anesthesiologists a greater understanding of the risk of NORA when compared to anesthesia in the operating room. Descriptions of advances in team training with the use of simulation have allowed the devel...
Source: Current Opinion in Anaesthesiology - May 13, 2020 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research