Editorial: Anesthesiologists should bring in their expertise during the early postoperative period to improve surgical outcome
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 14, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Editorial: Ambulatory anesthesia what's new in 2018
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 14, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Perioperative cognitive evaluation
This article reviews the recent clinical evidence published between January 2017 and June 2018 – related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention, diagnosis and diagnostic tools and treatment. Recent findings Several risk factors (preoperative, intraoperative and postoperative) have been found to be associated with the development of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD). Short-term and long-term postoperative consequences can be reduced by targeting risk factors, introducing preventive strategies and including frequent cogni...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Genetics of perioperative pain management
Purpose of review The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives. Recent findings Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl trans...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Echo-guided invasive pain therapy: indications and limitations
Purpose of review The purposes of this review are to summarize the advantages and limitations of ultrasound-guided pain interventions, and to illustrate those interventions with peripheral, axial and musculoskeletal pain procedures. Recent findings With the capability of locating the interfascial plane, ultrasonography has led to the emergence of a series of plane blocks for the thoracoabdominal region in the recent decade. Ultrasonography for musculoskeletal procedures has been of growing interest because of the major advantage of direct visualization and scanning of various soft tissues and real-time spread in the ...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Early warning scores in the perioperative period: applications and clinical operating characteristics
We describe a framework to evaluate the balance between missed events and warning signals that are not followed by an adverse event (nonevents). In large surgical cohort studies, the missed event rates ranged between 19 and 69% and the nonevent rates ranged between 72 and 99% for ’optimal’ threshold early warning sores. Recent investigations have shown that there may be a substantial discrepancy between the theoretical benefits shown in validation studies and the practical clinical implementation of early warning scores, which may partly explain the absence of measurable benefit from these systems. Summary E...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

What we can learn from Big Data about factors influencing perioperative outcome
Purpose of review This narrative review will discuss what value Big Data has to offer anesthesiology and aims to highlight recently published articles of large databases exploring factors influencing perioperative outcome. Additionally, the future perspectives of Big Data and its major pitfalls will be discussed. Recent findings The potential of Big Data has given an incentive to create nationwide and anesthesia-initiated registries like the MPOG and NACOR. These large databases have contributed in elucidating some of the rare perioperative complications, such as declined cognition after exposure to general anesthesia...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Postanesthesia care by remote monitoring of vital signs in surgical wards
Purpose of review This narrative review summarizes recent insights into the role of remote monitoring of vital signs in the postoperative period in surgical wards. Recent findings Despite recent improvements in the safety of anesthesia and surgical procedures, postoperative complication rates are still unacceptably high. This is partly attributable to the intermittent provision of personal care to patients by nurses and ward physicians. Continuous remote monitoring of vital functions in the early postoperative period may reduce these complication rates. There are several medical-grade remote monitoring platforms avail...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Anesthesiologists should bring in their expertise during the early postoperative period to improve surgical outcome
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Stephan A. Loer Source Type: research

Office-based surgery and patient outcomes
Purpose of review The purpose of this review is to provide an update on the current knowledge about patient safety and outcomes in the office-based setting. Ambulatory procedures performed outside the hospital are steadily increasing, resulting in an increasing number and complexity of office-based procedures and patient comorbidities over the past two decades. In this review we focus on most recent outcomes studies encompassing different surgical specialties and patient populations. Recent findings Rates of complications in the office-based surgical (OBS) setting from the latest publications are similar to, or lower ...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Best perioperative practice in management of ambulatory patients with obstructive sleep apnea
Purpose of review The perioperative outcome in obstructive sleep apnea (OSA) patients undergoing ambulatory surgery can be potentially impacted by the type of anesthetic technique, fluid management and choice of anesthetic agents. This review highlights the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures. Recent findings A recent meta-analysis found that STOP-Bang might be used as a perioperative risk stratification tool. Patients with high-risk OSA (STOP-Bang ≥3) were found to be associated with an increased risk of postoperative complications and prolonged ...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Perioperative management of the obese ambulatory patient
Purpose of review The prevalence of obesity continues to rise in developed countries. Increasingly, anaesthesiologists are faced with management of this cohort of patient in the ambulatory setting. This review summarizes the factors involved with such management of the obese patient as well as provision of guidance on recently accrued evidence. Recent findings A number of reviews have emphasized the value of preoperative assessment in ambulatory management for the obese, with emphasis on diagnosis, management and outcomes of patients with obstructive sleep apnoea. Drug delivery particularly with appropriate dose sched...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Novel analgesics in ambulatory surgical patients
Purpose of review The increasing number of procedures done in the ambulatory surgical setting necessitates the need for analgesic modalities that enable the management of postsurgical pain with fast onset, predictable duration of action, and minimal need for management of undesirable side-effects. Recent findings The novel strategies for administration of local anesthetics in the ambulatory setting include prolonging their analgesic action at the site of surgical trauma while reducing systemic effects that result from their metabolism. Development of opioids aims to address receptor sites that provide for modulation o...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Rebound pain after regional anesthesia in the ambulatory patient
Purpose of review Regional anesthesia is popular in ambulatory setting allowing safe and fast recovery. The problem of ‘rebound pain’, that is very severe pain when peripheral nerve block (PNB) wears off represents a clinically relevant problem and a cause of increased healthcare resource utilization. This review tries to make the point on a not so rare, unwanted and often neglected side effect of PNB. Recent findings The major finding is the lack of large prospective studies. Incidence of rebound pain is unknown but could reach 40% of patients at PNB resolution. To date, pathophysiological mechanisms rema...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Drug selection for ambulatory procedural sedation
Purpose of review Ambulatory procedural sedation is used to relieve anxiety, pain and discomfort in a broad spectrum of patients during many types of diagnostic or therapeutic procedures. This review focuses on recent comparative studies of commonly used and new drugs for adult ambulatory sedation. Recent findings Midazolam and propofol are commonly used for ambulatory sedation. Their pharmacological properties offer many advantages and there is much experience with their use. Ketamine can be a useful addition to hypnotic drugs but the advantage of the use of ketofol (a mixture of propofol and ketamine) is, although o...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Neuromonitoring in the ambulatory anesthesia setting: a pro–con discussion
Purpose of review Various neurologically focused monitoring modalities such as processed electroencephalography (pEEG), tissue/brain oxygenation monitors (SbO2), and even somatosensory evoked responses have been suggested as having the potential to improve the well tolerated and effective delivery of care in the setting of outpatient surgery. The present article will discuss the pros and cons of such monitors in this environment. Recent findings There is a paucity of evidence from rigorous, well designed clinical trials demonstrating that the routine use of any neuromonitoring technique in an ambulatory surgery settin...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Improving outcomes in ambulatory anesthesia by identifying high risk patients
Purpose of review Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. Recent findings Complications after ambulatory surgery are associated with age, higher American Society of Anesthesiologists physical status, obstruc...
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Ambulatory anesthesia: what's new in 2018
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 9, 2018 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Did ultrasound fulfill the promise of safety in regional anesthesia?
Purpose of review Ultrasound guidance has become the accepted standard of practice for peripheral regional anesthesia. Despite evidence supporting the efficacy of ultrasound-guided regional anesthesia, its impact on patient safety has been less clear. Recent findings Evidence has been consistent that ultrasound guidance reduces the incidence of vascular injury, local anesthetic systemic toxicity, pneumothorax and phrenic nerve block. Within the limited global scope of the epidemiology and etiologic complexity of perioperative (including block-related) peripheral nerve injury, there has not been consistent evidence tha...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

The road to accreditation for fellowship training in regional anesthesiology and acute pain medicine
Purpose of review The purpose of this review is to provide the background and rationale for pursuing accreditation of regional anesthesiology and acute pain medicine (RAAPM) fellowships, explain specific steps and challenges in the process, and forecast the future of fellowship training. Recent findings In 2016, the first fellowship program in RAAPM was able to apply for accreditation from the Accreditation Council for Graduate Medical Education (ACGME). The establishment of this newly accredited subspecialty fellowship and the announcement of the first accredited programs represented a tremendous achievement in anest...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Extended release bupivacaine formulations for postoperative analgesia: an update
Purpose of review New formulations of local anesthetics with sustained release and longer duration of action are being developed to improve patient outcomes following surgery. This review summarizes the efficacy and safety of the three most recently developed extended-release formulations of the local anesthetic, bupivacaine. Recent findings Bupivacaine liposome injectable suspension (EXPAREL) encapsulates bupivacaine in biodegradable liposomes. It is currently the only extended-release formulation of bupivacaine approved by the FDA for infiltration of the tissues during surgery and for interscalene nerve block analge...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

New blocks for the same old joints
Purpose of review New block techniques are being constantly developed or old techniques modified to improve outcomes after surgery. This review discusses the reasons why new block techniques need to be developed to match the needs of contemporary anesthetic practice. Recent findings New block techniques have been developed for joint surgeries of both upper and lower extremities. New upper extremity blocks focus on decreasing the risk of complications like diaphragmatic paresis and improving the quality of blocks. Techniques for lower extremity surgeries are being performed distally, closer to the joints, to minimize w...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Is epidural analgesia still a viable option for enhanced recovery after abdominal surgery
Purpose of review Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications. Recent findings In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility. Furthermore, TEA can reduce opioid-induced side effects, cardiac arrhythmia...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Informed consent for regional anesthesia
Purpose of review This narrative review describes the current framework for informed consent discussions for regional anesthesia practice from an ethical and medicolegal stand point as the cornerstone of the patient–physician relationship and the respect for patient autonomy. Recent guidelines and position statements from anesthesia societies have emphasized the importance of these discussions and their appropriate documentation. Recent findings Recent studies have shown that patients want to know more about both common and benign, as well as rare but serious adverse events, as it relates to their anesthetic car...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Recent developments in ultrasound imaging for neuraxial blockade
Purpose of review Recent research has shed further light on the place of ultrasound imaging in neuraxial blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. Recent findings Compared with the conventional technique of surface landmark palpation, preprocedural ultrasound imaging minimizes technical difficulty associated with lumbar neuraxial blockade in patients with poor-quality surface landmarks. Novice practitioners are able to learn to employ the technique effectively. Safety benefits include a reduction in postprocedural back pain associated with fewer n...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

An update on regional analgesia for rib fractures
Purpose of review To provide an update on new strategies for pain management after rib fractures utilizing regional analgesia. Recent findings Pain management for patients with rib fractures can be very challenging. Traditionally, intravenous patient-controlled analgesia (IVPCA) with opioids, epidural, and paravertebral blocks have been used. These techniques, however, may be contraindicated or have limited application in certain patient populations. Recently, ultrasound-guided myofascial plane blocks such as the erector spinae plane (ESP) block and the serratus anterior plane (SAP) block have emerged as alternatives;...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Outcomes of regional anesthesia in cancer patients
Purpose of review To summarize the current evidence on the impact of regional anesthesia or analgesia on cancer recurrence. Recent findings Preclinical investigations suggest that regional anesthesia could have a positive impact on reducing cancer growth and progression. Regional anesthesia is also associated with better immunological and stress-related outcomes in patients undergoing major oncological surgery. Most recent retrospective studies do not show any benefit of regional anesthesia or analgesia on cancer recurrence or recurrence-free survival. Summary The available clinical evidence does not support the us...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Regional anesthesia by nonanesthesiologists
Purpose of review As the evidence supporting the notion that regional anesthesia improves patient outcomes grows, utilization of regional anesthesia techniques has similarly increased. Best care should not be restricted by the background of care providers, however, the evidence replicating benefits of regional anesthesia when it is delivered by nonanesthesiologists is unclear. In this review, the provision of regional anesthesia by nonanesthesiologists is discussed so that readers can come to their own conclusions. Recent findings Regional anesthesia procedures are performed by nonanesthesiology physicians such as eme...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil M. Elkassabany Source Type: research

Mechanisms of acute and chronic pain after surgery: update from findings in experimental animal models
Purpose of review Management of postoperative pain is still a major issue and relevant mechanisms need to be investigated. In preclinical research, substantial progress has been made, for example, by establishing specific rodent models of postoperative pain. By reviewing most recent preclinical studies in animals related to postoperative, incisional pain, we outline the currently available surgical-related pain models, discuss assessment methods for pain-relevant behavior and their shortcomings to reflect the clinical situation, delineate some novel clinical-relevant mechanisms for postoperative pain, and point toward fu...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

Genetics and genomics in postoperative pain and analgesia
Purpose of review The review describes recent advances in genetics and genomics of postoperative pain, the association between genetic variants and the efficacy of analgesics, and the role of pharmacogenomics in the selection of appropriate analgesic treatments for postoperative pain. Recent findings Recent genetic studies have reported associations of genetic variants in catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF), voltage-gated channel alpha subunit 11 (SCN11A) and μ-opioid receptor (OPRM1) genes with postoperative pain. The recent pharmacogenetics studies revealed an association...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

Stratification of neuropathic pain patients: the road to mechanism-based therapy?
Purpose of review It has been demonstrated that within one pain entity, patients may report highly heterogenic sensory signs and symptoms. Although mechanism might differ fundamentally between those patients, yet the treatment recommendations are uniform throughout all phenotypes. Therefore, the introduction of new stratification tools could pave the way to an individualized pain treatment. Recent findings In the past, retrospective stratifications of patients successfully identified responders to certain pharmacological treatments. This indicated predictive validity and reliability of this classification tool in thos...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

Opioid-free anesthesia: a different regard to anesthesia practice
Purpose of review In the past two decades, opioids have been prescribed increasingly for the treatment of various chronic pain conditions and during the perioperative period. Perioperative opioid administration is associated with well known adverse effects and recently to long-term use and poor surgical outcomes. In this context, the anesthesiologists have to face their responsibilities. The review discusses the neurophysiological basis of opioid-free anesthesia (OFA), the rational supporting its use in perioperative medicine as well as barriers and future challenges in the field. Recent findings OFA has gained in pop...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Esther Pogatzki-Zahn Source Type: research

Traumatic brain injured patients: primum non nocere
Purpose of review Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one ‘treatment fits all’ approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. Recent findings Prehospital care teams which include a physician may reduce mortality. The commonly held value of SBP more than 90 in TBI is now being challenge...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Anesthesia for stroke rescue
Purpose of review To highlight the potential implications of recent advances in the management of large vessel occlusions for intraprocedural anesthetic management. Recent findings Stroke remains the leading cause of disability in the United States and the second leading cause of death in the world. Several randomized control trials published within the past decade have helped to make endovascular thrombectomy the standard of care for all eligible patients. However, whether intraprocedural anesthesia care practices may significantly improve in-hospital and out-of-hospital morbidity and mortality outcomes are not clear...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Pediatric neuroanesthesia
Purpose of review Pediatric neuroanesthesia is a fascinating, yet challenging branch of anesthesia. This review highlights some of the recent insights into pediatric neuroanesthesia from the past 18 months. Recent findings Although there are incontrovertible evidences in animals suggesting that prolonged exposure to general anesthesia causes long-term neurological impairment, the translational relevance of these findings in humans is debatable. Early surgery for pediatric drug-refractory epilepsy is supported by emerging literature, but poses unique perioperative problems for the treating neuroanesthesiologist. Simila...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Intraoperative neurophysiological monitoring in neuroanesthesia
Purpose of review The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM). Recent findings Over the last decades, neuromonitoring has advanced considerably, allowing for insights into neurological function during anesthesia and making it possible to assess intraoperative consciousness and neural integrity in real time. IONM is indicated in surgeries posing risk to targeted neural tissues a...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Fluid management concepts for severe neurological illness: an overview
Purpose of review The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. Recent findings In this review, several gaps in our collective knowledge are summarized, including a rigorous definition of volume status that can be practically measured; an understanding of how electrolyte derangements interact with therapy; a measurable endpoint ag...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Education in neuroanesthesia and neurocritical care: trends, challenges and advancements
Purpose of review We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. Recent findings Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies. Furthermore, there is increasing international int...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Periprocedural management of patients with subarachnoid hemorrhage
This article will review the recent advances in the periprocedural management of aSAH patients. Recent findings New scoring systems to assess gravity and prognosis of aSAH patients have been evaluated and proposed. Rebleeding still remains, with early aneurysmal treatment, a major challenge in the first hours of aSAH management. In the last decades, the treatment of the aSAH has shifted from clipping to coiling and more recently, the use of flow diversion technique has been introduced in selected patients. Although these improvements allow treatment of more complex aneurysms, they have implications for the anesthesiolog...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Anesthesia for awake craniotomy
Purpose of review The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. Recent findings Both approaches for anesthesia for awake craniotomy, asleep–awake–asleep and monitored anesthesia care (MAC), have shown equal efficacy for performing intraoperative brain mapping. Choice of the appropriate scheme is currently based mainly on the preferences of the particular anesthesiologist. Dexmedetomidine has demonstrated high efficacy and safety in MAC for a...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Anesthesia for electroconvulsive therapy
Purpose of review Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated. Recent findings Pretreatment with dexmedetomidine eased the propofol injection pain and reduced the hyperdynamic response to ECT, but prolonged recovery. Remifentanil exhibited no proconvulsive effect and had no...
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Neuroanesthesiology: building the path to superior clinical care through research and education
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Federico Bilotta Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - September 8, 2018 Category: Anesthesiology Tags: Editorial Introductions Source Type: research

Scheduling the nonoperating room anesthesia suite
Purpose of review Nonoperating room anesthesia (NORA) and procedural services often are associated with dispersed geographic settings and small volumes of cases. These lead to scheduling challenges that, if not managed well, result in decreased patient and healthcare team satisfaction and reduced efficiency. This review describes recent studies and provides examples on how NORA scheduling issues have been addressed. Recent findings Increased use of blocked time for consolidated NORA services can lead to sufficiently large volumes of cases that allow improved scheduling and maintain patient and healthcare team satisfac...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Nonoperating room anesthesia for gastrointestinal endoscopic procedures
Purpose of review To assess the trends in nonoperating room anesthesia (NORA) for gastrointestinal endoscopy over the past few years, and to describe alternative methods of delivering propofol sedation in selected low-risk patients. Recent findings The use of NORA for routine gastrointestinal endoscopic procedures has been rising steadily over the past decade in the United States, considerably increasing healthcare costs. Because of this, there have been attempts to develop nonanesthesiologist-administered propofol sedation methods in low-risk patients. There is controversy as to whether properly trained nonanesthesia...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Sedation for gastrointestinal endoscopy in Australia: what is the same and what is different?
Purpose of review The purpose of this article is to review the practice of sedation for adults having gastrointestinal endoscopy in Australia and to compare it with practice in other countries. Recent findings The practice of sedation for endoscopy in Australia is dominated by anaesthesiologists, who have a preference for deep propofol-based sedation. The recent literature includes a number of guidelines for sedation developed by multidisciplinary groups, anaesthesiologists and gastroenterologists in Australia and other countries. The appropriate health practitioner to provide deep sedation and general anaesthesia, to...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Endovascular thrombectomy in acute ischemic stroke: new treatment guide
Purpose of review Recent randomized clinical trials (RCTs) have demonstrated strong efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions (LVO). SIESTA, AnSTROKE, GOLIATH showed no deleterious effects of general anesthesia on patient outcome after EVT compared with conscious sedation. DAWN and DEFUSE 3 are extending the time window for EVT up to 24 h in carefully selected patients. This review discusses the current literature on the rapidly expanding subject of endovascular stroke therapy and optimal anesthetic management. Recent findings Recent retrospective studie...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

The future of anesthesia for interventional radiology
Purpose of review To review novel procedures in interventional radiology and describe anesthetic implications. Recent findings Noninvasive treatment options for patients who are nonsurgical candidates are on the rise. The complication rate for patients receiving anesthesia in the interventional radiology suite is higher than other nonoperating room anesthetizing locations. The investigative use of catheter-directed thrombolysis for acute submassive pulmonary embolism will likely lead to an increased demand for anesthesia assistance. Treatment of prostate cancer with high-intensity focused ultrasound with MRI guidance ...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Do we really need an anesthesiologist for routine colonoscopy in American Society of Anesthesiologist 1 and 2 patients?
Purpose of review In an era where healthcare costs are being heavily scrutinized, every expenditure is reviewed for medical necessity. Multiple national gastroenterology societies have issued statements regarding whether an anesthesiologist is necessary for routine colonoscopies in American Society of Anesthesiologist (ASA) 1 and 2 patients. Recent findings A large percentage of patients are undergoing screening colonoscopy without any sedation at all, which would not require an independent practitioner to administer medications. Advances in technique and technology are making colonoscopies less stimulating. Advantage...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research