Selective periarticular blocks for postoperative pain after hip and knee arthroplasty
Purpose of review This review aims to provide an overview of selective periarticular blocks for postoperative pain after hip and knee arthroplasty and the current evidence for their use. Recent findings Most interventional analgesia techniques for hip and knee arthroplasty result in a motor block and muscle weakness. Therefore, these are not well suited for fast-track protocols. In contrast, selective pericapsular infiltration techniques provide selective joint sensory block without an associated motor block. This facilitates postoperative pain management and avoids impairing ambulation and early rehabilitation....
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARY Source Type: research

Getting hit by the bus around the world – a global perspective on goal directed treatment of massive hemorrhage in trauma
This article summarizes main principles in coagulation diagnostics and compares different strategies for treatment of massive hemorrhage after trauma in different regions of the world. How would a bleeding trauma patient be managed if they got hit by the bus in the United States, United Kingdom, Germany, Switzerland, Austria, Denmark, Australia, or in Japan? Summary There are multiple coexistent treatment standards for trauma-induced coagulopathy in different countries and different trauma centers. Most of them initially follow a protocol-based approach and subsequently focus on predefined clinical and laboratory ta...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

Severe bleeding in the ICU
Purpose of review Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only. Recent findings Recent public...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

The multisystem inflammatory syndrome in children and its association to SARS-CoV-2
We describe the clinical presentation, diagnosis, and treatment recommendations. Recent finding To date, no randomized prospective studies have been published; recommendations are based on some observational studies, case reports, and expert opinions. The article provides an overview of the most important publications, presents the current results of the German Registry for PIMS and expert recommendations for treatment. Summary MIS-C PIMS is a new syndrome that is associated with a variety of virus infections, and also with SARS-CoV-2. The main characteristics are fever, multiple organ dysfunction due to a hy...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

Fibrinogen in traumatic haemorrhage
This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage. Recent findings Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

Prehospital administration of blood and plasma products
Purpose of review Posttraumatic bleeding following major trauma is life threatening for the patient and remains a major global health issue. Bleeding after major trauma is worsened by trauma-induced coagulopathy (TIC). TIC consists of acute trauma coagulopathy and resuscitation coagulopathy. The early diagnosis and management of prehospital TIC management are challenging. Recent findings Concepts for early diagnosis and management of civilian prehospital TIC management are evolving. The feasibility of prehospital blood component as well as coagulation factor transfusion has been proven. Summary Due to dif...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

Cell salvage in trauma
Purpose of review The collection of shed blood and its reinfusion has been termed ‘cell salvage’ or ‘autotransfusion’. This review will summarize the historical foundation of cell salvage and summarize recent literature associated with cell salvage use in trauma. Recent findings There have been no publications on cell salvage in trauma during the last 2 years. This is based on a PubMed search using the key words, ‘cell salvage’, ‘autologous blood transfusion’ and ‘operative blood salvage’. Although the wars in Iraq and Afghanistan were ongoing, publicat...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

Editorial: Challenges of the pandemics for trauma and transfusion management as well as state-of-the-art reviews
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research

Moderate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice
Purpose of review Interventional pain management procedures provide significant improvement to patient quality of life and functionality. In-office procedures are becoming an increasingly more common site of pain management intervention for patients with minimal risk of harm. Recent findings Moderate and deep sedation techniques can be used in patients with high anxiety, complex pharmacotherapy, or a low pain threshold. Proper guidance and oversight by an attending anesthesiologist, in addition to appropriate monitoring, are key. Epidural steroid injection complications rates have been cited at 2.4%, with the mo...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Advanced endoscopic gastrointestinal techniques for the bariatric patient: implications for the anesthesia provider
Purpose of review The incidence of obesity and the use of endoscopy have risen concurrently throughout the 21st century. Bariatric patients may present to the endoscopy suite for primary treatments as well as preoperatively and postoperatively from bariatric surgery. However, over the past 10 years, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as viable alternatives to more invasive surgical approaches for weight loss. Recent findings The United States Food and Drug Administration (FDA) has approved several different gastric EBMTs including aspiration therapy, intragastric balloons, and endo...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Preoperative optimization of patients undergoing interventional procedures: infrastructure, logistics, and evidence-based medicine
Purpose of review Patients presenting for non-operating room procedures are often ‘too sick’ for surgery and require specific anesthesia care in remote areas with logistical and scheduling challenges. Recent findings Increased complexity and scope of minimally invasive procedures have expanded this practice. In addition, the concept of therapeutic options other than conventional surgery is gaining traction. Summary Our review of recent literature confirms the complexity and supports the safety of providing care in non-operating room anesthesia locations. Standard preanesthesia assessments and ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Anesthetic Management of Acute Ischemic Stroke in the Interventional Neuro-Radiology Suite: State of the Art
Purpose of review This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke. Recent findings Recent randomized controlled trials have shown no differences in clinical outcomes between monitored anesthesia care with sedation compared with general anesthesia for endovascular stroke therapy. The COVID-19 pandemic has complicated decision-making in the neurointerventional setting. Advances in imaging techniques have extended the window of treatment for endovascular therapy. S...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Frameworks for trainee education in the nonoperating room setting
Purpose of review As the volume and types of procedures requiring anesthesiologist involvement in the nonoperating room anesthesia (NORA) setting continue to grow, it is important to create a formal curriculum and clearly define educational goals. Recent findings A NORA rotation should be accompanied by a dedicated curriculum that should include topics such as education objectives, information about different interventional procedures, anesthesia techniques and equipment, and safety principles. NORA environment may be unfamiliar to anesthesia residents. The trainees must also learn the principles of efficiency, ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics
This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. Recent findings National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Updates and controversies in anesthesia for advanced interventional pulmonology procedures
Purpose of review Advanced bronchoscopic procedures continues to grow, and are now commonly used to diagnose and/or treat a variety of pulmonary conditions that required formal thoracic surgery in past decades. Pharmacologic developments have provided new therapeutic options, as have technical advances in both anesthesia and interventional pulmonology. This review discusses technical and clinical issues and advances in providing anesthesia for advanced bronchoscopic procedures. It also discusses some controversial issues that have yet to be fully resolved. Recent findings We discuss anesthetic considerations for...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

An update on pediatric sedation techniques in nonoperating room locations
Purpose of review To review advancements in care for pediatric patients in nonoperating room settings. Recent findings Advances in patient monitoring technology, utilization of Child Life specialists, and alternative staffing models are helping anesthesia providers meet the rising demand for coverage of pediatric nonoperating room anesthesia (NORA) cases. The Wake Up Safe and Pediatric Sedation Research Consortium registries are exploring outcome measures regarding the safety of pediatric anesthesia in off-site locations and have reported an increased risk for severe respiratory and cardiac adverse events when c...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Medication safety in nonoperating room anesthesiology
Purpose of review Medication errors remain a prominent source of medical harm in spite of over 20 years of effort in establishing standardized protocols and procedures, implementing assistive electronic technologies to identify medications and prevent administration errors and in establishing a just culture with regard to reporting events and near misses. Recent findings Some of these interventions are even more necessary in the nonstandard environment of a non-operating room anesthesiology (NORA) procedure suite, where the anesthesiologist is often far removed from colleagues, in a dark room, lacking the standa...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Anaesthesia for minimally invasive cardiac procedures in the catheterization lab
Purpose of review The share of cardiac procedures performed in settings involving nonoperating room anaesthesia (NORA) continues to grow rapidly, and the number of publications related to anaesthetic techniques in cardiac catheterization laboratories is substantial. We aim to summarize the most recent evidence about outcomes related to type of anaesthetic in minimally invasive cardiac procedures. Recent findings The latest studies, primarily focused on transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr), demonstrate the need for reliable monitoring and appropriate training ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Patient monitoring in the nonoperating room anesthesia (NORA) setting: current advances in technology
Purpose of review Nonoperating room anesthesia (NORA) procedures continue to increase in type and complexity as procedural medicine makes technical advances. Patients presenting for NORA procedures are also older and sicker than ever. Commensurate with the requirements of procedural medicine, anesthetic monitoring must meet the American Society of Anesthesiologists standards for basic monitoring. Recent findings There have been improvements in the required monitors that are used for intraoperative patient care. Some of these changes have been with new technologies and others have occurred with software refinemen...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Editorial: Nonoperating room anesthesia in the era of value-based care
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA (NORA): Edited by Richard D. Urman Source Type: research

Drugs in anesthesia: preventing postoperative nausea and vomiting
Purpose of review Postoperative nausea and vomiting (PONV) continues to be a burden for patients, medical staff and healthcare facilities because of inadequate adherence to available recommendations. This review gives an overview on recent recommendations, new evidence and remaining issues in the field of PONV management. Recent findings A wide range of drugs is available for the management of PONV including corticosteroids, 5-HT3-antagonists, dopamine-antagonists, neurokinin-receptor-1 (NK1)-antagonists, antihistamines and anticholinergics. The updated PONV guidelines from 2020 recommend a universal multimodal ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Inhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation
We describe recent evidence examining the benefits and harms associated with their use. Recent findings The environmental harms associated with desflurane and nitrous oxide likely outweigh any purported clinical benefits. Life cycle analyses are beginning to address the many gaps in our understanding, and informing choices made on all aspects of anaesthetic care. There is, however, an urgent need to move beyond the debate about anaesthetic technique A vs. B and focus also on areas such as sustainable procurement, waste management, pharmacological stewardship and joined-up solutions. Summary There is now compe...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Preoperative laboratory testing in elderly patients
Purpose of review Preoperative testing in elderly patients is performed to examine the patient's current medical condition in the context of evaluating vulnerabilities and predicting postoperative complications to ensure that all functions recover before surgery. This review focused on preoperative laboratory tests in geriatric patients. Recent findings Preoperative complete blood count, electrolyte testing, and blood chemistry can predict postoperative complications. Preoperative elevated morning/evening salivary cortisol secretion ratio, C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratios, and...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Recent advances in understanding cognitive and behavioural alterations after early-in-life anaesthesia exposure and new mitigation/alternative strategies in preclinical studies
Purpose of review Long-term behavioural and cognitive impairments after exposure to general anaesthetics during infancy is an intensely investigated and controversial topic. Recent clinical studies with prospective assessments associate exposure with long-term behavioural alterations rather than cognitive impairments. This review aims to provide an understanding of the long-term cognitive impairments and behavioural alterations found in recent animal studies and to summarize latest advances in strategies to protect against anaesthesia-induced developmental neurotoxicity (AIDN). Recent findings Preclinical studie...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Ready for a “breakthrough” with ketamine? A look at recent pharmacological insights!
Purpose of review To update pharmacological insights on ketamine integrating information from different disciplines for developing steps to “breakthrough” approaches in clinical challenges. Recent findings Pharmacokinetic/pharmacodynamic (PK/PD) models have incorporated recirculation, ketamine metabolites, drug–drug interaction, and covariates such as age. Ketamine-induced relief from treatment-resistant depression has been explained by “disinhibition” of gamma-aminobutyric acid-ergic interneurons and synaptogenic mechanisms requiring neurotrophic signals. Neuroimaging/electroenceph...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

The disruptive physician and impact on the culture of safety
Purpose of review The disruptive physician is a growing problem in medicine. All too often, physician behavior negatively impacts the delivery of quality patient care. The hostile environment that certain behaviors create makes it difficult for team members advocate for their patients. It is imperative that physician practices develop and an understanding of how to identify the disruptive physician to maintain patient safety. Recent findings Disruptive physicians can damage team morale by creating a psychologically unsafe working environment. Healthcare organizations must be committed to ensuring that all team m...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARY Source Type: research

Myocardial injury after noncardiac surgery – an update
Purpose of review After successfully reducing mortality in the operating room, the time has come for anesthesiologists to conquer postoperative complications. This review aims to raise awareness about myocardial injury after noncardiac surgery (MINS), its definition, diagnosis, clinical importance, and treatment. Recent findings MINS, defined as an elevated postoperative troponin judged to be due to myocardial ischemia (with or without ischemic features), occurs in up to one in five patients having noncardiac surgery and is responsible for 16% of all postoperative deaths within 30 days of surgery. New evidence...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Perioperative frailty: lessons learned and future directions
This article reviews current conceptual frameworks of frailty, references current literature and provides a practical approach to the preoperative frailty assessment with a focus on potential interventions. Recent findings A multipronged approach toward preoperative optimization should be used in patients with frailty syndrome. Oral protein supplementation and immunonutrition therapy can reduce complications in patients with malnutrition. Initiating a preoperative physical exercise regimen may mitigate frailty. Nonpharmacologic interventions to reduce preoperative anxiety and improve mood are effective, low-cost adj...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

How new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury
Purpose of review Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evi...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Immunomodulators in anesthesia
Purpose of review Anesthetics are known to have immunomodulatory effects. These can be detrimental, inducing immunosuppression and facilitating the development of opportunistic infections, especially when used at high doses, for prolonged periods, or in patients with preexisting immune deficiency; or beneficial, modulating the inflammatory response, particularly in critical illness and systemic hyperinflammatory states. Recent findings Anesthetics can have microbicidal properties, and both anti- and pro-inflammatory effects. They can act directly on immune cells as well as modulate immunity through indirect path...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Current concepts in the evaluation and management of preoperative anemia
Purpose of review In the past years, patient blood management (PBM) has evolved to improve patient‘s care and safety. Anemia is one of the most common medical diseases in the world and is an independent risk factor for morbidity and mortality. Iron deficiency is the main cause for anemia and constitutes a potentially preventable condition with a great impact on surgical outcome. However, preoperative anemia management is not yet established in most hospitals. Changing workflows and re-thinking is challenging. Numerous published studies confirmed the positive effect of preoperative anemia diagnosis and treatment r...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Patients with psychiatric disease: implications for anesthesiologists
Purpose of review Psychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities. Recent findings As new treatment modalities become available, their perioperative implications need to be evaluated. These implications include drug–drug interactions, hemodynamic effects, bleeding risk, and factors affecting perioperative exacerbation of the underlying psychiatric illness. Summary From our review of the recent literature we continue to support the continuation of psychoactive agents in the perio...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Perioperative thrombocytopenia
Purpose of review In this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia. Recent findings Large contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic plat...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Endocrine emergencies in anesthesia
Purpose of review An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients. Recent findings Perioperative management of pheochromocytoma and paraganglioma has been facilitated by improved medical management and the adoption of minimally invasive surgical techniques. An improved understanding of the sequelae of carcinoi...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Anesthetic technique and cancer surgery outcomes
Purpose of review Surgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes. Recent findings To date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to de...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Perioperative risk assessment – focus on functional capacity
Purpose of review This review examines how functional capacity informs preoperative risk stratification, as well as strengths and limitations of options for estimating functional capacity. Recent findings Functional capacity (or cardiopulmonary fitness) overlaps with other important characteristics, including muscular strength, balance, and frailty. Poor functional capacity is associated with postoperative morbidity, especially noncardiovascular complications. Both patient interviews and exercise tests are used to assess functional capacity. The usual approach of an unstructured patient interview does not predic...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Editorial: Perioperative medicine: a bridge (not) too far!
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research

Pediatric obesity and perioperative medicine
Purpose of review Childhood obesity is a public health emergency that has reached a pandemic level and imposed a massive economic burden on healthcare systems. Our objective was to provide an update on (1) challenges of obesity definition and classification in the perioperative setting, (2) challenges of perioperative patient positioning and vascular access, (3) perioperative implications of childhood obesity, (3) anesthetic medication dosing and opioid-sparing techniques in obese children, and (4) research gaps in perioperative childhood obesity research including a call to action. Recent findings Despite the n...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

Coronavirus disease 2019 and pediatric anesthesia
Purpose of review The purpose of this review is to provide the latest evidence for delivering safe and effective anesthesia care for pediatric patients with coronavirus disease 2019 (COVID-19) and to highlight continuing gaps in the literature. Recent findings Safe and efficient care of pediatric patients with COVID-19 can be delivered with the proper planning, coordination, supplies, and staff preparation. From the start of the pandemic, pediatric anesthesiologists from around the world contributed important insights and shared experience as to how best to adapt anesthesia care for children with COVID-19 requir...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

Virtual reality for pediatric periprocedural care
Purpose of review Commercial availability of virtual reality headsets and software has exponentially grown over the last decade as it has become more sophisticated, less expensive, and portable. Although primarily used by the general public for entertainment, virtual reality has been adopted by periprocedural clinicians to improve patient experiences and treatments. The purpose of this review is to explore recently reported evidence for virtual reality effectiveness for pediatric periprocedural care and discuss considerations for clinical implementation. Recent findings In the preprocedure setting, practitioners...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

Pediatric airway management
Purpose of review Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019–2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice. Recent findings Recent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempt...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

A decade later, there are still major issues to be addressed in paediatric anaesthesia
Purpose of review Despite real advances in paediatric anaesthesia management, such as a growing awareness of the relevance of anaesthesia conduct as well as of the lack of evidence for neurotoxicity of anaesthetic agents, it must be said that there are still important questions in our specialty that remain unanswered. Standardization and harmonization of airway management, analgesia techniques and outcome measures are the important issues we are facing at the beginning of this decade. Recent findings Major improvements in airway management of neonates and infants resulted from the introduction of videolaryngosco...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

Editorial: Assembling pediatric anesthesiology experts during a pandemic – a story of gratitude, resilience and cooperation
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Jorge A. Gálvez Source Type: research

Advances in anesthetic and obstetric management of patients with placenta accreta spectrum
Purpose of review The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist. Recent findings Recent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. N...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research

Maternal sepsis update
Purpose of review Maternal sepsis is the second leading cause of maternal death in the United States. A significant number of these deaths are preventable and the purpose of this review is to highlight causes such as delays in recognition and early treatment. Recent findings Maternal sepsis can be difficult to diagnose due to significant overlap of symptoms and signs of normal physiological changes of pregnancy, and current screening tools perform poorly to identify sepsis in pregnant women. Surveillance should not only include during pregnancy, but also throughout the postpartum period, up to 42 days postpart...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research

Management of maternal COVID-19: considerations for anesthesiologists
Purpose of review To describe updates to pragmatic recommendations that were published during the first coronavirus disease 2019 (COVID-19) surge, including the current thinking about whether pregnancy worsens the severity of COVID-19. Recent findings Although a majority of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain asymptomatic or paucisymptomatic, pregnancy puts women at higher risk of severe COVID-19 and adverse birth outcomes. Pregnant and recently pregnant women are more likely to be admitted to intensive care units and receive mechanical ventilation tha...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research

Anesthetic management for robotic hysterectomy in obese women
Purpose of review Obesity is a major health epidemic, with the prevalence reaching ∼40% in the United States in recent years. It is associated with increased risk of hypertension, diabetes, heart disease, stroke, obstructive sleep apnea (OSA), and gynecologic conditions requiring surgery. Those comorbidities, in addition to the physiologic changes associated with obesity, lead to increased risk of perioperative complications. The purpose of this review is to highlight the anesthetic considerations for robotic assisted hysterectomy in obese patients. Recent findings In the general gynecologic population, mini...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research

Perinatal depression
This article reviews current understandings about birth events on depression, new screening standards, and novel treatments for postpartum depression. Recent findings Pain, analgesia, and depression are complex traits that are inter-related during and after pregnancy. Certain individuals may benefit more than others from addressing pain and suffering around childbirth. Exposures to general anesthesia or postdural puncture headache are associated with postpartum depression symptoms, although a causal relationship is unlikely. Brexanolone, ketamine and its related compounds, and nonpharmacologic options offer new or a...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research

Peripartum management for women with opioid dependence
Purpose of review Opioid use disorder (OUD) in pregnancy has more than quadrupled in prevalence over the past two decades and continues to increase steadily every year. With no defined standard of care for the management of pain during the peripartum period, variability in treatment plans potentially leaves room for interrupted patient care, decreased patient satisfaction, and poorer outcomes. The impact of OUD and its management during the peripartum period has become more widely discussed over the past several years and is the focus of this review. Recent findings Current recommendations including developing a...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research