Anesthesia-induced immune modulation
Purpose of review Surgery, invasive procedures and anesthesia itself may induce an inflammatory response in the patient. This represents an evolutionary inherited and conserved response of the host to environmental stimuli and may lead to both beneficial and potentially harmful effects. This review highlights the mechanisms of anesthesia-induced and perioperative immune modulation. Recent findings The innate and adaptive immune system serve the host in protection against invading pathogens. Yet, an inflammatory immune response may also be induced by different noninfectious stimuli, for example invasive perioperative p...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Emerging indications for hyperbaric oxygen
Purpose of review To identify and discuss emerging trends in the therapeutic use of hyperbaric oxygen. Recent findings There has been a maturing of the clinical evidence to support the treatment of sudden hearing loss, a wide range of problematic chronic wound states and the prevention and treatment of end-organ damage associated with diabetes mellitus. On the other hand, the controversy continues concerning the use of hyperbaric oxygen therapy (HBOT) to treat sequelae of mild traumatic brain injury. HBOT remains poorly understood by many medical practitioners despite more than 50 years of clinical practice. Pharmacol...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Benefits and harms of increased inspiratory oxygen concentrations
Purpose of review The topic of perioperative hyperoxia remains controversial, with valid arguments on both the ‘pro’ and ‘con’ side. On the ‘pro’ side, the prevention of surgical site infections was a strong argument, leading to the recommendation of the use of hyperoxia in the guidelines of the Center for Disease Control and the WHO. On the ‘con’ side, the pathophysiology of hyperoxia has increasingly been acknowledged, in particular the pulmonary side effects and aggravation of ischaemia/reperfusion injuries. Recent findings Some ‘pro’ articles leading to t...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Anaesthetic considerations in nonagenarians and centenarians
Purpose of review The ageing population is a global public health issue and we can expect to encounter more and more older patients requiring anaesthetic care. Age itself is no longer the sole reason for declining a patient for anaesthesia and surgery. Undoubtedly, managing patients at the extremities of age is challenging and demanding, not only because of multiple comorbidities, but also the poorer functional status, frailty and decline in general well being that must be managed during the perioperative journey. In this article, we will focus on three important aspects of anaesthetic care for this patient group, namely...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Indications, contraindications, and safety aspects of procedural sedation
Purpose of review There is a steadily increasing demand for procedural sedation outside the operating room, frequently performed in comorbid high-risk adult patients. This review evaluates the feasibility and advantages of sedation vs. general anesthesia for some of these new procedures. Recent findings Generally, sedation performed by experienced staff is safe. Although for some endoscopic or transcatheter interventions sedation is feasible, results of the intervention might be improved when performed under general anesthesia. For elected procedures like intra-arterial treatment after acute ischemic stroke, avoiding ...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Awake videolaryngoscopy versus fiberoptic bronchoscopy
Purpose of review The difficult airway remains an ongoing concern in daily anesthesia practice, with awake intubation being an important component of its management. Classically, fiberoptic bronchoscope-assisted tracheal intubation was the method of choice in the awake patient. The development of new generation videolaryngoscopes has revolutionized the approach to tracheal intubation in the anesthetized patient. The question whether videolaryngoscopes have a place in the intubation of the difficult airway in the awake patient is currently being addressed. Recent findings Randomized controlled trials and their meta-ana...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Editorial: Moving boundaries in anaesthesiology
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Office-based anesthesia: an update on safety and outcomes (2017–2019)
Purpose of review Although both cost and patient preference tend to favor the office-based setting, one must consider the hidden costs in managing complications and readmissions. The purpose of this review is to provide an update on safety outcomes of office-based procedures, as well as to identify common patient-specific factors that influence the decision for office-based surgery or impact patient outcomes. Recent findings Office-based anesthesia (OBA) success rates from the latest publications of orthopedic, plastic, endovascular, and otolaryngologic continue to improve. A common thread among these studies is the a...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Safety in office-based anesthesia: an updated review of the literature from 2016 to 2019
This article provides a practical approach to discuss and analyze newest literature supporting different practices in the field of OBA. In addition, an update of the most recent guidelines and practice management directives is included. Recent findings Selected procedures may be performed in the office-based scenario with exceedingly low complication rates, when the right patient population is selected, and adequate safety protocols are followed. Current regulations are focused on reducing surgical risk through the implementation of patient safety protocols and practice standardization. Strategies include cognitive aids...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Procedural sedation in ambulatory anaesthesia: what's new?
Purpose of review Although sedation traditionally has been regarded as an easy, straight forward and simple variety of general anaesthesia; the trends are to make sedation more sophisticated and dedicated. Also to have a critical look at old dogmas, as they are usually derived from the practice of general anaesthesia. Safety always has to be first priority, especially as the practice grows out of traditional theatres and frequently are being practiced by nonanaesthetic personnel. Recent findings Safety comes from learning of rare cases with severe problems as well as better guidelines and rules of accreditation. Furth...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Anesthesia for thoracic ambulatory surgery
Conclusion ERATS program may lead to improved outcomes including decreased length of stay, but it is currently too early to show the impact on thoracic ambulatory surgery that concerned selected patients for lung resection. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Pain monitor: reality or fantasy in ambulatory patients
Purpose of review In an unconscious patient, there can be significant challenges to monitoring nociception and proper dosing of analgesic medications. The traditional measures of intraoperative nociception have poor sensitivity and specificity with little predictive value in postoperative outcomes such as postoperative pain, opioid-induced side effects, length of stay or incidence of opioid use disorder. To date, several monitoring modalities are in development to establish objective measures of the balance between nociception and analgesia with the goal of guiding anesthesiologists and improve patient outcomes. In this ...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery
Purpose of review The present review aims to propose pharmacological strategies to enhance current clinical practices for analgesia in ambulatory surgical settings and in the context of the opioid epidemic. Recent findings Each year, a high volume of patients undergoes ambulatory surgery worldwide. The multimodal analgesia proposed to ambulatory patients must provide the best analgesic effect and patient satisfaction while respecting the rules of safety for ambulatory surgery. The role of nurses, anesthesiologists, and surgeons around said surgery is to relieve suffering, achieve early mobilization and patient satisfa...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

How to optimize neuromuscular blockade in ambulatory setting?
Purpose of review The purpose of this review is to discuss the optimal use of neuromuscular blocking agents (NMBA) during ambulatory surgery, and to provide an update on the routine use of neuromuscular monitoring and the prevention of residual paralysis. Recent findings The number of major surgical procedures performed in ambulatory patients is likely to increase in the coming years, following the development of laparoscopic and thoracoscopic procedures. To successfully complete these procedures, the proper use of NMBA is mandatory. The use of NMBA not only improves intubating conditions but also ventilation. Recent ...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Pediatric ambulatory anesthesia: an update
Purpose of review Ambulatory surgery is the standard for the majority of pediatric surgery in 2019 and adenotonsillectomy is the second most common ambulatory surgery in children so it is an apt paradigm. Preparing and managing these children as ambulatory patients requires a thorough understanding of the current literature. Recent findings The criteria for undertaking pediatric adenotonsillectomy on an ambulatory basis, fasting after clear fluids, postoperative nausea and vomiting (PONV), perioperative pain management and discharge criteria comprise the themes addressed in this review. Summary Three criteria deter...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Total intravenous anaesthesia in ambulatory care
Purpose of review The purpose of this article is to review the use of total intravenous anaesthesia (TIVA) in ambulatory care. Recent findings The number of ambulatory surgery cases is likely to increase in coming years. Recent meta-analyses suggest that TIVA offers decreased postoperative nausea and vomiting (PONV) and decreased pain scores in the postanaesthesia care unit (PACU) in day case/ambulatory surgery patients when compared with volatile anaesthesia. Particular improvements have also been shown in endoscopic nasal surgery in terms of decreased blood loss. TIVA consistently scores higher than volatile techniq...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Recovery and discharge criteria after ambulatory anesthesia: can we improve them?
Purpose of review Day surgery coming and leaving hospital day of surgery is growing. From minor and intermediate procedure performed on health patient, day surgery is today performed on complex procedures and elderly patient and on patients with comorbidities. Thus, appropriate discharge assessment is of huge importance to secure safety and quality of care. Recent findings Discharge has since decades been assessed on a combination of stable vital signs, control of pain and postoperative nausea and vomiting and securing that patients can stand walk unaided. There is controversy around whether patients must drink and vo...
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Editorial: Current Opinion in Anesthesiology: : new editor announcement
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 5, 2019 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Regional anesthesia for vascular surgery: does the anesthetic choice influence outcome?
Purpose of review Outcomes following surgery are of major importance to clinicians, institutions and most importantly patients. This review examines whether regional anesthesia and analgesia influence outcome after vascular surgery. Recent findings Large database analyses of contemporary practice suggest that utilizing regional anesthesia for both open and endovascular aortic aneurysm repair, lower limb revascularization and carotid endarterectomy reduces morbidity, length of stay and possibly even mortality. Results from such analyses are limited by an inherent risk of bias but are nevertheless important given the nu...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Regional anesthesia and pain management in patients with sleep apnea: can they improve outcomes?
Purpose of review In several guidelines, regional anesthesia and analgesia have been suggested as safer alternatives for general anesthesia and systemic analgesia for their safety profile in patients suffering from obstructive sleep apnea (OSA). However, the underlying scientific basis is still evolving. The present review is intended to provide an up-to-date account on the question whether the use of regional anesthesia improves outcomes in patients with OSA. Recent findings A number of studies found favorable effects of regional anesthesia used in patients with OSA, including reduced incidence of major perioperative...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Regional anesthesia for cardiac surgery
Purpose of review Anesthesia for cardiac surgery has traditionally utilized high-dose opioids to blunt the sympathetic response to surgery. However, recent data suggest that opioids prolong postoperative intubation, leading to increased morbidity. Given the increased risk of opioid dependency after in-hospital exposure to opioids, coupled with an increase in morbidity, regional techniques offer an adjunct for perioperative analgesia. The aim of this review is to describe conventional and emerging regional techniques for cardiac surgery. Recent findings Well-studied techniques such as thoracic epidurals and paravertebr...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Persistent postoperative pain: mechanisms and modulators
This article reviews the current thought processes on mechanisms and modulators from a basic science and epidemiological perspective. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Can recent chronic pain techniques help with acute perioperative pain?
This article discussed how the knowledge and technique of a few chronic pain procedures benefited the perioperative clinicians in their care of patients receiving specific orthopaedic surgical procedures. Recent findings Recent emerging interest in hip and knee denervation for chronic pain management secondary to osteoarthritis stimulates publications on the new understanding of hip and knee joint innervation. The improved understanding of the anatomy allows better precision in targeting the articular branches. The procedures for chronic joint pain such as radiofrequency ablation, chemical neurolysis and neuromodulation...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Primer on machine learning: utilization of large data set analyses to individualize pain management
Purpose of review Pain researchers and clinicians increasingly encounter machine learning algorithms in both research methods and clinical practice. This review provides a summary of key machine learning principles, as well as applications to both structured and unstructured datasets. Recent findings Aside from increasing use in the analysis of electronic health record data, machine and deep learning algorithms are now key tools in the analyses of neuroimaging and facial expression recognition data used in pain research. Summary In the coming years, machine learning is likely to become a key component of evidence-b...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Updates on pediatric regional anesthesia safety data
Purpose of review The clinical practice of anesthesia continues to evolve and grow toward increasing quality and safety while improving the patient and family perioperative experience. Within the realm of pediatric anesthesia, advances in regional anesthesia techniques are important part in this aim. Recent findings The aim of this review is to provide an update on recent advances in pediatric regional anesthesia. This includes an emphasis on safety data from large datasets that previously were not available. In addition, novel blocks within pediatric regional anesthesia will be described. Summary Large data sets h...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Essential elements of an outpatient total joint replacement programme
Purpose of review To summarize the safety and feasibility of outpatient total joint arthroplasty (TJA) from the perspectives of short-term complications, long-term functional outcomes, patient satisfaction and financial impact, and to provide evidence-based guidance on how to establish an outpatient TJA programme. Recent findings TJA has been recently transitioned from an exclusively inpatient procedure for all Medicare and Medicaid patients to an outpatient surgery in properly selected total knee arthroplasty patients. This change may decrease costs while maintaining comparable rates of readmission, adverse events, p...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Functional anatomy of the nerve and optimal placement of the needle for successful (and) safe nerve blocks
Purpose of review Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. Recent findings The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks. In this kind of blocks, the target for injection is the plane itself and not a nerve in particular. transversus abdominis plane, pectoralis muscles, erector spinae plane blocks are some...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

Editorial: Regional anesthesiology and acute pain medicine in 2020 and beyond
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research

The role of gabapentinoids in acute and chronic pain after surgery
Purpose of review Gabapentinoid use has increased substantially in the past several years after initial promising data with regard to acute perioperative pain control. The purpose of this review is to critically appraise the evidence for the use of gabapentinoids for acute pain management and its impact on the development of chronic pain after surgery. Recent findings Recent meta-analyses have revealed that prior data likely have overestimated the beneficial effects of gabapentinoids in acute perioperative pain while underestimating the associated adverse effects. The utility of gabapentinoids in the setting of enhanc...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

Cannabis-based medicines for chronic pain management: current and future prospects
Purpose of review The medicinal use of cannabis has recently become the focus of much medical, as well as political, attention. This reality of growing use but limited evidence creates unique dilemmas for the prescribing clinician. The purpose of this review is to explore current evidence and gaps in knowledge and offer some practical considerations. Recent findings There is robust preclinical data regarding the relevance of the endocannabinoid system to many pain-relevant processes. However, evidence to support cannabis-based medicines clinical use is still lacking. The best evidence to date is in managing neuropathi...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

Patient-reported outcome measures for acute and chronic pain: current knowledge and future directions
Purpose of review During the past years, patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) have become of growing awareness and importance in medical research and practice. This review summarizes recent developments concerning PROs and PROMs related to pain in the acute postoperative as well as chronic settings and indicates gaps and challenges relevant for future research and clinical applications. Recent findings There are core outcome sets (COSs) of PROs and PROMs developed for specific pain conditions but patients’ perception is not sufficiently considered in the development of c...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

The impact of frailty and sarcopenia on patient outcomes after complex spine surgery
Purpose of review Frailty and sarcopenia represent a state of increased fragility and decreased reserve, and both have been associated with worse outcomes after surgery. The present review focuses on the definitions and measurement tools used to assess frailty and sarcopenia in patients with spinal disorder, and the relationships between frailty, sarcopenia, and postoperative outcomes in patients undergoing complex spine surgery. Recent findings Complex spine surgery is associated with a high rate of adverse events when using a validated, prospective data collection system. Recent studies have demonstrated that patien...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Anesthetic management of complex spine surgery in adult patients: a review based on outcome evidence
Purpose of review The aim of this article is to review the evidence regarding the anesthetic management of blood loss, pain control, and position-related complications of adult patients undergoing complex spine procedures. Recent findings The most recent evidence of the anesthetic management of complex spine surgery was identified with a systematic search and graded. In our review, prophylactic tranexamic acid and optimal prone positioning were shown to be effective blood conservation strategies with minimal risks to the patients. Cell saver was cost-effective in complex surgeries with expected blood loss of greater t...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Multimodal analgesia for craniotomy
Purpose of review To explore the data for and against the use of the various components of multimodal analgesia in cranial neurosurgery. Recent findings Postcraniotomy pain is a challenging clinical problem in that analgesia must be accomplished without affecting neurologic function (i.e. ‘losing the neurologic exam’). The traditional approach with low-dose opioids is often insufficient and can cause well recognized side effects. Newer multimodal analgesic approaches have proven beneficial in a variety of other surgical patient populations. The combined use of multiple nonopioid analgesics offers the promi...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Anaesthesia for stroke thrombectomy: technical considerations based on outcome evidence
Purpose of review Stroke is the second leading cause of death and the third leading cause of disability worldwide. Treatment is time limited and delays cost lives. This review discusses modern stroke management, during a time when treatments and guidelines are rapidly evolving. Recent findings Stroke thrombectomy has become the therapy of choice for large vessel occlusion (LVO) strokes. Perfusion imaging techniques, both computed tomography (CT) and MRI, now allow treatment beyond a set time window in specific patients. Both general anaesthesia and conscious sedation are options for patients undergoing stroke thrombec...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Neurophysiological monitoring during neurosurgery: anesthetic considerations based on outcome evidence
This article reviews the recent outcome studies that investigated intraoperative neurophysiological monitoring (IONM) during spine, neurovascular and brain tumor surgery. Recent findings Several recent studies have focused on identifying which types of neurosurgical procedures might benefit most from IONM use. Despite conflicting literature regarding its efficacy in improving neurological outcomes, many experts have advocated for the use of IONM in neurosurgery. Several themes have emerged from the recent literature: the entire perioperative team must always work together to ensure adequate communication and interventio...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Transfusion in adults and children undergoing neurosurgery: the outcome evidence
Purpose of review Transfusion is a common practice during neurosurgery. However, there is no evidence-based consensus on transfusion practice in neurosurgery. This review summarizes the evidence pertinent to the commonly used transfusion triggers in neurosurgical patients. Recent findings In the field of neurosurgery, there is only one randomized controlled trial, performed in patients with traumatic brain injury, to investigate the transfusion trigger of red blood cells. There is a lack-of-quality evidence pertinent to the transfusion triggers of other blood products. Most of the transfusion triggers used for neurosu...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Hyperventilation in neurological patients: from physiology to outcome evidence
Purpose of review Hyperventilation is commonly used in neurological patients to decrease elevated intracranial pressure (ICP) or relax a tense brain. However, the potentially deleterious effects of hyperventilation may limit its clinical application. The aim of this review is to summarize the physiological and outcome evidence related to hyperventilation in neurological patients. Recent findings Physiologically, hyperventilation may adversely decrease cerebral blood flow (CBF) and the match between the cerebral metabolic rate and CBF. In patients with severe traumatic brain injury (TBI), prolonged prophylactic hyperve...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Neurological complications after cardiac surgery: anesthetic considerations based on outcome evidence
Purpose of review Neurological complications after cardiac surgery remain prevalent. This review aims to discuss the modifiable and outcome-relevant risk factors based on an up-to-date literature review, with a focus on interventions that may improve outcomes. Recent findings There is a close relationship between intraoperative blood pressure and postoperative neurological outcomes in cardiac surgical patients based on cohort studies and randomized controlled trials. Adopting an optimal and personalized blood pressure target is essential; however, the outstanding issue is the determination of this target. Maintaining ...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Anesthesia and brain tumor surgery: technical considerations based on current research evidence
Purpose of review Anesthetics may influence cancer recurrence and metastasis following surgery by modulating the neuroendocrine stress response or by directly affecting cancer cell biology. This review summarizes the current evidence on whether commonly used anesthetics potentially affect postoperative outcomes following solid organ cancer surgery with particular focus on neurological malignancies. Recent findings Despite significant improvement in diagnostic and therapeutic technology over the past decades, mortality rates after cancer surgery (including brain tumor resection) remains high. With regards to brain tumo...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Awake craniotomy: anesthetic considerations based on outcome evidence
Purpose of review This review highlights anaesthesia management options for awake craniotomy and discusses the advantages and disadvantages of different approaches, intraoperative complications and future directions. Recent findings For lesions located within or adjacent to eloquent regions of the brain, awake craniotomy allows maximal tumour resection with minimal consequences on neurological function. Various techniques have been described to provide anaesthesia or sedation and analgesia during the initial craniotomy, and rapid return to consciousness for intraoperative testing and tumour resection; there is no evid...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Neuroanesthesia and outcomes: evidence, opinions, and speculations on clinically relevant topics
The objective of this review is to identify outstanding topics most relevant to neuroanesthesia practice and patient outcomes. We discuss the role of awake craniotomy, choice of general anesthetic agents, monitoring of anesthetic ‘depth’, mannitol-induced diuresis, neurophysiological monitoring, hyperventilation, and cerebral hypoperfusion. Recent findings Awake craniotomy, although a technique likely underused, is associated with enhanced recovery after surgery and prolonged survival after brain tumor resection compared with surgery under general anesthesia. The choice of general anesthetic must balance pat...
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - August 30, 2019 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Anesthesia-administered sedation for endoscopic retrograde cholangiopancreatography: monitored anesthesia care or general endotracheal anesthesia?
Purpose of review The decision to undertake monitored anesthesia care (MAC) or general endotracheal anesthesia (GEA) for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is influenced by many factors. These include locoregional practice preferences, procedure complexity, patient position, and comorbidities. We aim to review the data regarding anesthesia-administered sedation for ERCP and identify the impact of airway management on procedure success, adverse event rates and endoscopy unit efficiency. Recent findings Several studies have consistently identified patients at high risk for sedation...
Source: Current Opinion in Anaesthesiology - June 28, 2019 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Anesthesia practice for endovascular therapy of acute ischemic stroke in Europe
Purpose of review Anesthetic assistance is often required during endovascular therapy (EVT) of large vessel occlusion in patients with acute ischemic stroke. It is currently debated whether EVT should be performed under general anesthesia or conscious sedation. This review will summarize the recent literature with emphasis on the influence of anesthesia method on neurological outcome. Recent findings Recent randomized trials have reported no difference in outcome after EVT performed under either conscious sedation or general anesthesia. This is in contrast to a substantial number of retrospective studies, which found ...
Source: Current Opinion in Anaesthesiology - June 28, 2019 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Anesthesia and airway management for gastrointestinal endoscopic procedures outside the operating room
Purpose of review To review the anesthestic and airway management for gastrointestinal procedures outside of the operating room. Recent findings The number of gastrointestinal endoscopic procedures performed is steadily increasing worldwide. As complexity, duration and invasiveness of procedures increase, there is ever greater requirement for deeper sedation or general anesthesia. A close relationship between anesthetic practitioners and endoscopists is required to ensure safe and successful outcomes. The American Society of Gastrointestinal endoscopy and the British Society of Gastroenterology have recently released ...
Source: Current Opinion in Anaesthesiology - June 28, 2019 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Anesthesia for peroral endoscopic myotomy in Japan
Purpose of review Peroral endoscopic myotomy (POEM) was developed in Japan as a less invasive treatment for esophageal achalasia requiring general anesthesia under positive pressure ventilation. In 2018, the Japan Gastroenterological Endoscopy Society published the first guidelines describing the standard care for POEM. Based on these guidelines, we discuss the typical approach to anesthesia during POEM for the management of esophageal achalasia in Japan. Recent findings Prior cleansing of the esophagus is essential to prevent both aspiration during induction of anesthesia and contamination of the mediastinum and thor...
Source: Current Opinion in Anaesthesiology - June 28, 2019 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Safety in the nonoperating room anesthesia suite is not an accident: lessons from the National Transportation Safety Board
Purpose of review To review the findings of National Transportation Safety Board-related aviation near misses and catastrophes and apply these principles to the nonoperating room anesthesia (NORA) suite. Recent findings NORA is a specialty that has seen tremendous growth. In 2019, NORA contributes to a larger proportion of anesthesia practice than ever before. With this growth, the NORA anesthesiologist and team are challenged to provide safe, high-quality care for more patients, often with complex comorbidities, and are forced to utilize deeper levels of sedation and anesthesia than ever before. These added pressures...
Source: Current Opinion in Anaesthesiology - June 28, 2019 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Efficiency and scheduling in the nonoperating room anesthesia suite: implications from patient satisfaction to increased revenue operating room: a common (Dollars and Sense) approach
Purpose of review Although the NORA setting continues to outgrow the main operating room in cases, there are few studies addressing efficiency metrics, and even fewer studies addressing those of a single specialty outpatient gastroenterology facility. In order to capitalize on this growing trend, gastrointestinal endoscopies must be scheduled in a way that prevents lost potential revenue while maintaining patient convenience, comfort, safety, and satisfaction. By standardizing our scheduling for procedure block time among various endoscopists and converting our sedation practices from conscious sedation to solely Propofo...
Source: Current Opinion in Anaesthesiology - June 28, 2019 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research