The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists
Purpose of review There has been a substantial increase in prescription and illicit opioid abuse in the general population observed over the last two decades. Initially fueled by an influx of prescription opioid medications, the opioid epidemic now includes increasingly potent heroin and illicit fentanyl. Younger anesthesiologists, those currently in training or recent graduates, have come of age in a society where opioid abuse is much more prevalent. Recent findings The current prevalence of substance use disorder (SUD) in the physician population is slightly higher than in the general population and appears to be in...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Peer support in anesthesia: turning war stories into wellness
Purpose of review Peer support, a method of providing for the well being of healthcare providers following adverse or stressful events, is garnering increased attention in light of the increased prevalence and awareness of burnout, depression and suicidality in physicians. In this review, we will summarize the evolution of the ‘second victim,’ explore methods of support and examine how new regulatory requirements are changing the peer support landscape. Recent findings As peer support and the second victim are investigated more, themes are emerging regarding the natural history of recovery. As these are de...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Wellness interventions for anesthesiologists
Purpose of review The review examines the different preventive measures that have been found to be useful to abolish or decrease the negative effects of burnout and increase resilience in anesthesiologists. Recent findings Studies in anesthesiology cite autonomy, control of the work environment, professional relationships, leadership, and organizational justice as the most important factors in job satisfaction. Factors such as difficulty in balancing personal and professional life, poor attention to wellness, work alcoholism, and genetic factors increase an individual's susceptibility to burnout. Exposure to chronic o...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Disruptive behavior in the operating room: prevalence, consequences, prevention, and management
Purpose of review Disruptive workplace behavior can have serious consequences to clinicians, institutions, and patients. There is a range of disruptive behaviors, and the consequences are often underappreciated. The purpose of this manuscript is to review the definition, prevalence, consequences, prevention, and management of disruptive behavior in the operating room. Recent findings Although a small minority of operating room clinicians act disruptively, 98% of clinicians report having recently been exposed to disruptive behavior, with the average being 64 events per clinician per year. The causes include intraperson...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

The role of feedback in ameliorating burnout
Purpose of review Assessment of the current literature surrounding interventions directed toward the prevention of burnout in the field of medicine and particularly in anesthesiology. Recent findings Recently, burnout has been noted to lead to medication errors and subsequently increased harm to our patients. On a personal level, burnout can lead to depression and even suicide amongst physicians. Strategies to prevent burnout amongst anesthesiologists that have been studied in the literature include multisource feedback, mentorship and early recognition. Summary There remains no clear or definitive intervention to ...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Technology as friend or foe? Do electronic health records increase burnout?
Purpose of review To summarize recent relevant studies regarding the use of electronic health records and physician burnout. Recent findings Recently acquired knowledge regarding the relationship between electronic health record use, professional satisfaction, burnout, and desire to leave clinical practice are discussed. Summary Adoption of electronic health records has increased across the United States and worldwide. Although electronic health records have many benefits, there is growing concern about the adverse consequences of their use on physician satisfaction and burnout. Poor usability, incongruent workflow...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Occupational stress, burnout and personality in anesthesiologists
This article will discuss the topic of stress and burnout in relationship to anesthesiologists’ personality based on recent literature. Recent findings Studies among anesthesiologists are in concordance with the broader body of literature on this topic. Personality consistently influences stress appraisal and coping and consequently the development of burnout. Neuroticism, negative affectivity and cooperativeness all contribute to burnout. Summary Strategies to alleviate stress and hence the development of burnout should not only be directed at adapting occupational or organizational factors but also at equippi...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Wellness in anaesthesia
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by John E. Ellis Source Type: research

Preoperative fasting guidelines in pediatric anesthesia: are we ready for a change?
Purpose of review Study after study shows that prolonged fasting before anesthesia is common in children. Pediatric anesthesiologists around the world are concerned that the current guidelines may be part of the problem. This review focuses on what can be done about it. Recent findings We discuss new insights into the physiology of gastric emptying of different categories of food and drink. The evidence for negative effects of prolonged fasting occurring in spite of implementation of the current guidelines is examined. We also critically appraise the concept of a strict association between fasting time and the risk of...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Drug error in paediatric anaesthesia: current status and where to go now
Purpose of review Medication errors in paediatric anaesthesia and the perioperative setting continue to occur despite widespread recognition of the problem and published advice for reduction of this predicament at international, national, local and individual levels. Current literature was reviewed to ascertain drug error rates and to appraise causes and proposed solutions to reduce these errors. Recent findings The medication error incidence remains high. There is documentation of reduction through identification of causes with consequent education and application of safety analytics and quality improvement programs ...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Acute pain management in children: challenges and recent improvements
Purpose of review The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain. Recent findings Interpatient variability in postoperative pain is currently managed by applying protocols or by trial and error, thus often leading to patients being eit...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Perioperative considerations for airway management and drug dosing in obese children
Purpose of review Childhood obesity, a phenomenon that is increasing globally, holds substantial relevance for pediatric anesthesia. In particular, understanding the nuances of airway management and drug dosing in obese children can be daunting. Recent findings Respiratory adverse events and challenges in managing the airway may be anticipated. In addition, drug-dosing strategies for the obese child are complex and poorly understood although recent advances have clarified the optimal dosing for anesthetics in these children. Summary Theoretical knowledge, practical skills, meticulous risk stratification and optimal...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Intraoperative blood pressure levels in young and anaesthetised children: are we getting any closer to the truth?
Purpose of review Blood pressure is a basic feature of monitoring during anaesthesia. However, it is very unclear what blood pressures are normal during anaesthesia in children. Furthermore, the clinical consequences of low blood pressure are also uncertain. Similarly, it is unclear when to initiate therapy for hypotension during anaesthesia. This review summarizes the most recent development on the interpretation of blood pressure measurements in children and the relation of low blood pressure to clinical outcome. Recent findings Recently published (multicentre) database studies show that alleged complications of int...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

A different perspective: anesthesia for extreme premature infants is there an age limitation or how low should we go?
Purpose of review To put in perspective, the various challenges that faces pediatric anesthesiologists because of the recently lowered limits with regards to the viability of a fetus. Both medical and ethical considerations will be highlighted. Recent findings Issues related to: who should anesthetize these tiny babies; can we provide adequate and legal monitoring during the anesthetic; does these immature babies need hypnosis and amnesia and the moral/ethical implications associated with being involved with care of doubtful long-term outcome are reviewed. Summary There does currently not exist sufficient research ...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Is spinal anaesthesia in young infants really safer and better than general anaesthesia?
Purpose of review Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. Recent findings Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early ( (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Long-term neurocognitive outcomes following surgery and anaesthesia in early life
Purpose of review Repeated controversial and alarming statements of the potential dangers of anaesthetic agents on neurological outcomes in children continue to be issued based primarily on preclinical studies. This review assesses the current evidence of laboratory and clinical data and identifies areas of concerns. Recent findings Published animal and laboratory data consistently indicate that prolonged and excessive use of anaesthetic agents can lead to morphological changes and neurocognitive impairment in animals without a clear cut-off age or a superiority of one technique over another. Retrospective human studi...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Pediatric anesthesia after APRICOT (Anaesthesia PRactice In Children Observational Trial): who should do it?
Purpose of review This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. Recent findings A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries. Relevantly, quality improvement programs have been implemented in North America, which precisely define the requirements to manage anesthesia car...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Paediatric anaesthesia: a rapidly evolving subspecialty
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Tom G. Hansen Source Type: research

Clinical pearls part 3: anaesthetic management of abnormally invasive placentation
This article summarizes the current evidence for interventions and suggests a protocol for the management of these high-risk patients. Summary A robust protocol outlining the key elements of the management of placenta accreta, including optimizing postoperative care, should be in place to promote desired outcomes. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

Anesthesia and analgesia for gynecological surgery
Purpose of review High-quality analgesia has been linked to improved patient satisfaction as well as improved short-term and long-term postoperative outcomes. Acute surgical pain is a modifiable risk factor for development of chronic postoperative pain, which is reported by up to 26% of gynecologic surgical patients. In other surgical populations, multimodal analgesia has shown improved pain control and decreased reliance on opioids. This review examines recent evidence for various analgesic modalities applied specifically to the gynecologic surgical population. Recent findings Nonopioid agents like acetaminophen, non...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

Chronic pain after hysterectomy
Purpose of review Hysterectomy is a common surgical procedure with a low risk of major complications. However, some women experience long-lasting complications, including chronic postsurgical pain, which can have a negative impact on their quality of life. This review aims to present the recent literature on chronic pain following hysterectomy for benign indications. Recent findings Chronic pain following hysterectomy is reported in 10–50% of women. Risk factors include preoperative pelvic pain, pain elsewhere, acute postoperative pain, surgical procedure, and psychological factors such as anxiety and depression...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

Postoperative cesarean pain: real but is it preventable?
Purpose of review Cesarean section is the most common surgical procedure performed in the world. Postoperative pain management remains a challenge, particularly in a context of enhanced recovery after surgery. Several barriers related to the specific condition of ‘postpartum recovery’ may prevent application of effective analgesia in this population. The present review focuses on novel approaches of cesarean section postoperative pain assessment, beyond pain-rating intensity, including objective patient-centered recovery parameters. Predictive tools currently available to target patients at high risk of acute...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

Severe perineal lacerations after vaginal delivery: are they an anesthesiologist's problem?
Purpose of review Perineal tears or lacerations are common occurrences after vaginal delivery. Understanding the degree of severity of these tears and the immediate and long-term complications of severe perineal lacerations can assist anesthesiologists with the management of these patients in the immediate postpartum period. Recent findings Severe perineal lacerations have a high degree of association with postpartum depression. The presence of neuraxial labor analgesia decreases the odds of severe perineal lacerations. Summary Neuraxial labor analgesia does not directly predispose parturients to the development of...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

Neuraxial labor analgesia: a focused narrative review of the 2017 literature
Purpose of review Neuraxial labor analgesia remains the most effective and one of the most commonly utilized methods for pain relief during labor. This narrative review article is a summary of the literature published in 2017 on neuraxial analgesia for labor. Recent findings From a total of 41 identified articles, 13 were included in the review. The topics have been structured into three categories: initiation of neuraxial analgesia, maintenance of neuraxial analgesia, and neuraxial analgesia and obstetric outcomes. Maintenance regimens, such as program intermittent epidural bolus (PIEB) techniques, remain a focus of ...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

The opioid epidemic and pregnancy: implications for anesthetic care
Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medicat...
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jeanette Bauchat Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 30, 2018 Category: Anesthesiology Tags: Editorial Introductions Source Type: research

Trauma and transfusion in the geriatric patient
This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population. Should blood that is new lead to better outcomes than blood that was collected more than 14 days from the injury? What role does patient frailty have in trauma and transfusion outcomes? Is the massive transfusion protocol safe for the geriatric population? As this subset of the population grows, the number of patients on anticoagulation therapy will grow. Knowledge of the bone marrow plays an important role in geriatric trauma. How does head trauma in the elderly differ from the yo...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Storage injury and blood transfusions in trauma patients
Purpose of review The aim of the present review was to concisely summarize recent studies and current knowledge about effects of red blood cell storage injury in trauma patients. Recent findings Despite a pathophysiological rationale for older packed red blood cells (PRBCs) being associated with adverse events in the host organism, recent large clinical trials failed to show negative effects of transfusion with older PRBCs on clinically relevant outcomes in mixed patient population. However, there is a lack of well-designed randomized controlled trials focusing on the effects of storage lesion of PRBCs in trauma patie...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Fibrinolysis and antifibrinolytic treatment in the trauma patient
Purpose of review The role of antifibrinolytics in trauma haemorrhage and early coagulopathy remains controversial with respect to patient selection, dosage, timing of treatment, and risk of thrombotic complications. This review presents our current understanding of the mechanisms of fibrinolysis in trauma, diagnostic evaluation, and the evidence base for treatment. Recent findings Excessive fibrinolysis following severe injury is a major component of acute traumatic coagulopathy and contributes to the high mortality from trauma haemorrhage. The protein C pathway, endothelial dysfunction, platelet activity, shock, and...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Transfusion practices in traumatic brain injury
Purpose of review The aim of this review is to summarize the recent studies looking at the effects of anemia and red blood cell transfusion in critically-ill patients with traumatic brain injury (TBI), describe the transfusion practice variations observed worldwide, and outline the ongoing trials evaluating restrictive versus liberal transfusion strategies for TBI. Recent findings Anemia is common among critically-ill patients with TBI, it is also thought to exacerbate secondary brain injury, and is associated with an increased risk of poor outcome. Conversely, allogenic red blood cell transfusion carries its own risk...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Deep vein thrombosis and venous thromboembolism in trauma
Purpose of review Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject of research and debate. Recent findings Elements of the patient's history and physical examination, along with thromboelastography, can be used to predict patients who are at greatest risk of DVT and venous thromboembolism (VTE). Novel assays and biomarkers hold promise for m...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Blood transfusion management in the severely bleeding military patient
Purpose of review Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient. Understanding the life-threatening nature of coagulopathy of trauma and implementing strategies aimed at full spectrum hemorrhage manage...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Pediatric trauma transfusion and cognitive aids
This article explores new research from the past year in pediatric trauma, starting with the physiologic differences in pediatric red blood cells and coagulation profiles. We also looked at the dramatic change in thinking over the past decade in the tolerable level of anemia in critically ill pediatric patients, as well as scales for determining the need for massive transfusion and exploring if the concepts of damage control resuscitation apply to children. Other strategies, such as avoiding hypothermia, and the selective administration of antifibriniolytics, are important in pediatric trauma as well. Future research that ...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey S. Scher Source Type: research

Staff and family response to end-of-life care in the ICU
Purpose of review End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. Recent findings EOL care is a risk factor for clinician burnout; poor work conditions contribute to emotional exhaustion and intent to leave. The impact of EOL care on families is part of the acute Family Intensive Care Unit Syndrome (FICUS) and the Post Inte...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum Source Type: research

The ethics of interventional procedures for patients too ill for surgery
Purpose of review Minimally invasive interventional procedures are increasingly popular options for patients who are high-risk candidates for open surgical procedures. It is unclear how to proceed in the rare circumstance of a complication during an interventional procedure, where addressing the complication would require exposing the patient to the full risk that was being avoided with the minimally invasive technique. This review provides recommendations on how to approach this paradoxical scenario. Recent findings Risk stratification, communication frameworks, and advanced care planning can facilitate shared decisi...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum Source Type: research

Spirituality at the end of life
Purpose of review There is increasing emphasis on medical care of the whole patient. This holistic approach encompasses supporting the spiritual or religious needs of the patient. Particularly at the end of life, spiritual concerns may come to the fore as patients recognize and accept their impending death. Physicians may also recognize this spiritual distress but may not be clear on how to provide spiritual support. Recent findings Tools to screen for spiritual concerns are available for physicians to use. Some physicians wish to go further, supporting patients at the end of life in their spiritual quest. Other physi...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum Source Type: research

Withdrawal of life-sustaining therapy
This article addresses the withdrawal of left ventricular assist devices; attending physicians and physicians in training perspectives of WLST; do physicians distinguish between withholding and WLST; the timing of WLST; guidelines for the process of WLST; and pediatrics and end-of-life decisions. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum Source Type: research

Worldwide end-of-life practice for patients in ICUs
Purpose of review Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent findings Recent observational a...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum Source Type: research

Role of the anesthesiologist-intensivist outside the ICU: opportunity to add value for the hospital or an unnecessary distraction?
Purpose of review Given the extremely expensive nature of critical care medicine, it seems logical that intensivists should play an active role in designing efficient systems of care. The true value of intensivists, however, is not well defined. Recent findings Anesthesiologists have taken key roles in improving patient safety in the operating room. Anesthesia-related mortality rates have decreased from 20 deaths per 100 000 anesthetics in the early 1980s to less than one death per 100 000 currently. Anesthesiologist-intensivists remain rare (less than 5% of certified anesthesiologists), but increasingly play mult...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Cardiac dysfunction in critical illness
Purpose of review Sepsis and septic shock are prevalent conditions that are likely to increase in prevalence in the future. Given the high mortality and morbidity associated with sepsis and sepsis-induced cardiac dysfunction, we must continue to make advances in knowledge of the complex physiologic interactions and how we may target specific mediators for potential therapeutic options in the future. Recent findings Multiple biomarkers have been discovered, which when assayed in sepsis-induced cardiomyopathy predict morbidity and mortality. With increased sensitivity of echocardiography, we can diagnose subclinical car...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Renal replacement therapy in critically ill patients: who, when, why, and how
Purpose of review The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. Recent findings Critically ill patients are exposed to multiple factors known to deteriorate kidney function. Especially severe fluid overload is strongly associated with worse outcome and may be considered as a trigger for initiating RRT. In the absence of life-threatening complicati...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Recent evidence on early mobilization in critical-Ill patients
Purpose of review To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field. Recent findings Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsisten...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Nutrition in the ICU: new trends versus old-fashioned standard enteral feeding?
Purpose of review The narrative review aims to summarize the relevant studies from the last 2 years and provide contextual information to understand findings. Recent findings Recent ICU studies have provided insight in the pathophysiology and time course of catabolism, anabolic resistance, and metabolic and endocrine derangements interacting with the provision of calories and proteins. Early provision of high protein intake and caloric overfeeding may confer harm. Refeeding syndrome warrants caloric restriction and to identify patients at risk phosphate monitoring is mandatory. Infectious complications of parenteral...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Oxygen in the critically ill: friend or foe?
Purpose of review To examine the potential harmful effects of hyperoxia and summarize the results of most recent clinical studies evaluating oxygen therapy in critically ill patients. Recent findings Excessive oxygen supplementation may have detrimental pulmonary and systemic effects because of enhanced oxidative stress and inflammation. Hyperoxia-induced lung injury includes altered surfactant protein composition, reduced mucociliary clearance and histological damage, resulting in atelectasis, reduced lung compliance and increased risk of infections. Hyperoxemia causes vasoconstriction, reduction in coronary blood fl...
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Intensive care practitioner: I forgot half the things I learned and the other half seems to be all wrong!
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 1, 2018 Category: Anesthesiology Tags: Editorial Introductions Source Type: research

Drug-induced sleep endoscopy: from obscure technique to diagnostic tool for assessment of obstructive sleep apnea for surgical interventions
Purpose of review Provide a practical update on drug-induced sleep endoscopy (DISE) for anesthesia providers, which can also serve as a reference for those preparing to establish a DISE program. Recent findings New developments in surgical approaches to OSA and the growing global incidence of the condition have stimulated increased interest and demand for drug-induced sleep endoscopy. New techniques include transoral robotic surgery and hypoglossal nerve stimulation. Recent DISE literature has sought to address numerous debates including relevance of DISE findings to those during physiologic sleep and the most appropr...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Risk factors for opioid-induced respiratory depression and failure to rescue: a review
Purpose of review The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. Recent findings In the postoperative period, OIRD has often been reported resulting in morbidity and mortality. The risk factors which predispose surgical patients to increased risk of OIRD are not clearly defined. A literature search was performed for adult surgical patients who were prescribed opioids during their hospital stay and any available reports on postoperative respiratory depression/respiratory events. Summary Elderly, female sex, presence o...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Obstructive sleep apnea and bariatric surgical guidelines: summary and update
Purpose of review Increasing numbers of bariatric surgical procedures and the high prevalence of obstructive sleep apnea (OSA) in this population have resulted in a growing interest in the perioperative management of OSA in bariatric surgery. This review provides a summary of the first consensus guideline on this topic as well as an update of the newest literature available. Recent findings All bariatric patients should be screened for OSA and obesity hypoventilation syndrome (OHS) to reduce the risk of perioperative complications. Intraoperative precautions are preoxygenation, induction and intubation in ramped posit...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Anticipated and unanticipated difficult airway management
Purpose of review Management of difficult airway is far from optimal despite of continuous progress in science and technology. The purpose of this review is to summarize the current research in the field and bring readers up to date. Recent findings New technologies for intubation make providers more confident to handle difficult airways, but there is lack of evidence indicating the reduction in incidence of ‘cannot intubate cannot ventilate (CICV)’. Optimization of mask ventilation should reduce the incidence of difficult mask ventilation but it is greatly underappreciated. Even optimization of preoxygena...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research