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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

An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea
Purpose of review There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. Recent findings Recent knowledge on phenotypes and endotypes has provided a better understanding of the disease ...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Improve postoperative sleep: what can we do?
Purpose of review We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. Recent findings Normal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces ...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Perioperative pulmonary thromboembolism: current concepts and treatment options
Purpose of review Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy. Rece...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

The perioperative significance of systemic arterial diastolic hypertension in adults
Purpose of review Hypertension affects approximately one third of the U.S. population and is the most common preventable medical reason that surgical cases are postponed or cancelled. However, subtypes of hypertension and their perioperative risks are poorly studied and understood. We will review the natural history and pathophysiology of essential hypertension and discuss the perioperative significance of diastolic blood pressure elevation. Recent findings There is evidence that elevated preoperative diastolic blood pressures are associated with an increased perioperative risk of cardiovascular and cerebrovascular ev...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Postoperative thrombocytopenia: why you should consider antiplatelet therapy?
Purpose of review This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. Recent findings Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state a...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Vitamin C in sepsis
Purpose of review This narrative review summarizes recent insights into the role of vitamin C in sepsis. Recent findings Septic shock remains a major source of morbidity and mortality in critically ill patients. Although many nutritional supplements have previously been tested unsuccessfully, vitamins are still being explored as a therapeutic option in septic patients. In particular, vitamin C-containing regimens as adjunctive therapy in sepsis have received much attention. Summary In-vitro evidence supports a critical role for vitamin C in cellular mechanisms relevant to the pathophysiology of sepsis. However, whe...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Surgery and discontinuation of angiotensin converting enzyme inhibitors: current perspectives
Purpose of review The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period. Recent findings In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications. Summary Since the introduction of ACEIs and ARBs into clinical practice, their use during the perioperative period has been controversial. Althoug...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Intraoperative vasoplegia: methylene blue to the rescue!
Purpose of review To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). Recent findings Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of ...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Perioperative steroid therapy: where's the evidence?
Purpose of review Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. Recent findings Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability. Summary Current recommendations for per...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Enhanced recovery for thoracic surgery in the elderly
Purpose of review Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. Recent findings Elderly patients undergoing less radial surgical resections without lymphadenectomy have comparable outcomes to those undergoing classical curative treatment. Patients require careful assessment and self-reported quality...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Perioperative neurocognition in elderly patients
Purpose of review The extrinsic risk factors for postoperative cognitive disturbance have been a source of concern during the perioperative period, and these risk factors remain the subject of controversy. This review of recent studies focuses on the effect of these factors on postoperative cognitive disturbance during the perioperative period. Recent findings Impairment of cerebral autoregulation may predispose patients to intraoperative cerebral malperfusion, which may subsequently induce postoperative cognitive disturbance. The neurotoxicity of several volatile anesthetics may contribute to cognitive functional dec...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Pulmonary effects of aging
Purpose of review As the population ages, the increase in chronic illnesses among patients with decreasing lung function will pose a major public health challenge. Determining which elderly patients are fit for surgery is an increasingly important skill. Anesthetic care of elderly patients requires an understanding of the effects that chronic diseases have on normal age-related changes in physiology and function. Postoperative respiratory complications are significantly increased in patients over 65 years of age, especially those with preexisting diseases. Recent findings Advanced age is associated with changes in the...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Pharmacological considerations in the elderly
Purpose of review This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly. Recent findings Potency of anesthetic drugs is increased in the elderly. In addition to changes at the receptor level, neurophysiological changes in functional connectivity with aging contributes to increased sensitivity of anesthetic drugs. However, the extent of reducti...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Oncologic considerations in the elderly
Purpose of review Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. Recent findings Lung resections appears to be relatively safe in the elderly patients presenting with lung cancer. Whenever possible, a lobectomy should be offered to patients with a good performance status who present with early stage disease. ...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

An overview of perioperative considerations in elderly patients for thoracic surgery: demographics, risk/benefit, and resource planning
Purpose of review Increasing numbers of geriatric patients will present for thoracic surgery as the population ages. The changes in physiologic reserve as well as the increase in comorbid conditions among this population must be considered in order to optimize patient care in the perioperative period. Recent findings For elderly patients with cancer, the risk–benefit relationship for thoracic surgery remains favorable. Consideration of comorbidities, especially chronic obstructive pulmonary disease and congestive heart failure, is important in the setting of surgical treatment, as they have implications for peri...
Source: Current Opinion in Anaesthesiology - January 17, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 17, 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 2, 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 2, 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 2, 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 2, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea
Purpose of review There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. Recent findings Recent knowledge on phenotypes and endotypes has provided a better understanding of the disease ...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Improve postoperative sleep: what can we do?
Purpose of review We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. Recent findings Normal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces ...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: MORBID OBESITY AND SLEEP APNEA: Edited by Frances F. Chung Source Type: research

Perioperative pulmonary thromboembolism: current concepts and treatment options
Purpose of review Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy. Rece...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

The perioperative significance of systemic arterial diastolic hypertension in adults
Purpose of review Hypertension affects approximately one third of the U.S. population and is the most common preventable medical reason that surgical cases are postponed or cancelled. However, subtypes of hypertension and their perioperative risks are poorly studied and understood. We will review the natural history and pathophysiology of essential hypertension and discuss the perioperative significance of diastolic blood pressure elevation. Recent findings There is evidence that elevated preoperative diastolic blood pressures are associated with an increased perioperative risk of cardiovascular and cerebrovascular ev...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Postoperative thrombocytopenia: why you should consider antiplatelet therapy?
Purpose of review This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. Recent findings Our recent findings suggest that in some patients, the hemostatic balance during and after surgery may shift toward a hypercoagulable state a...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Vitamin C in sepsis
Purpose of review This narrative review summarizes recent insights into the role of vitamin C in sepsis. Recent findings Septic shock remains a major source of morbidity and mortality in critically ill patients. Although many nutritional supplements have previously been tested unsuccessfully, vitamins are still being explored as a therapeutic option in septic patients. In particular, vitamin C-containing regimens as adjunctive therapy in sepsis have received much attention. Summary In-vitro evidence supports a critical role for vitamin C in cellular mechanisms relevant to the pathophysiology of sepsis. However, whe...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Surgery and discontinuation of angiotensin converting enzyme inhibitors: current perspectives
Purpose of review The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period. Recent findings In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications. Summary Since the introduction of ACEIs and ARBs into clinical practice, their use during the perioperative period has been controversial. Althoug...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Intraoperative vasoplegia: methylene blue to the rescue!
Purpose of review To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS). Recent findings Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of ...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Perioperative steroid therapy: where's the evidence?
Purpose of review Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. Recent findings Evidence suggests low incidence of perioperative adrenal insufficiency in patients receiving chronic glucocorticoid therapy. Recent studies show no difference in survival or hemodynamic sequella by withholding perioperative stress steroids; however, these studies are limited in size and universal applicability. Summary Current recommendations for per...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Enhanced recovery for thoracic surgery in the elderly
Purpose of review Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. Recent findings Elderly patients undergoing less radial surgical resections without lymphadenectomy have comparable outcomes to those undergoing classical curative treatment. Patients require careful assessment and self-reported quality...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Perioperative neurocognition in elderly patients
Purpose of review The extrinsic risk factors for postoperative cognitive disturbance have been a source of concern during the perioperative period, and these risk factors remain the subject of controversy. This review of recent studies focuses on the effect of these factors on postoperative cognitive disturbance during the perioperative period. Recent findings Impairment of cerebral autoregulation may predispose patients to intraoperative cerebral malperfusion, which may subsequently induce postoperative cognitive disturbance. The neurotoxicity of several volatile anesthetics may contribute to cognitive functional dec...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Pulmonary effects of aging
Purpose of review As the population ages, the increase in chronic illnesses among patients with decreasing lung function will pose a major public health challenge. Determining which elderly patients are fit for surgery is an increasingly important skill. Anesthetic care of elderly patients requires an understanding of the effects that chronic diseases have on normal age-related changes in physiology and function. Postoperative respiratory complications are significantly increased in patients over 65 years of age, especially those with preexisting diseases. Recent findings Advanced age is associated with changes in the...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Pharmacological considerations in the elderly
Purpose of review This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly. Recent findings Potency of anesthetic drugs is increased in the elderly. In addition to changes at the receptor level, neurophysiological changes in functional connectivity with aging contributes to increased sensitivity of anesthetic drugs. However, the extent of reducti...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Oncologic considerations in the elderly
Purpose of review Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. Recent findings Lung resections appears to be relatively safe in the elderly patients presenting with lung cancer. Whenever possible, a lobectomy should be offered to patients with a good performance status who present with early stage disease. ...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

An overview of perioperative considerations in elderly patients for thoracic surgery: demographics, risk/benefit, and resource planning
Purpose of review Increasing numbers of geriatric patients will present for thoracic surgery as the population ages. The changes in physiologic reserve as well as the increase in comorbid conditions among this population must be considered in order to optimize patient care in the perioperative period. Recent findings For elderly patients with cancer, the risk–benefit relationship for thoracic surgery remains favorable. Consideration of comorbidities, especially chronic obstructive pulmonary disease and congestive heart failure, is important in the setting of surgical treatment, as they have implications for peri...
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Paul M. Heerdt Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 2, 2018 Category: Anesthesiology Tags: Editorial Introductions Source Type: research

Role of in-situ simulation for training in healthcare: opportunities and challenges
Purpose of review Simulation has now been acknowledged as an important part of training in healthcare, and most academic hospitals have a dedicated simulation center. In-situ simulation occurs in patient care units with scenarios involving healthcare professionals in their actual working environment. The purpose of this review is to describe the process of putting together the components of in-situ simulation for training programs and to review outcomes studied, and challenges with this approach. Recent findings In-situ simulation has been used to ‘test-drive’ new centers, train personnel in new procedures...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Optimizing education in difficult airway management: meeting the challenge
Purpose of review The last 2 decades have seen a vast change in the science and technology of airway management. As a result, there is an increasing need to equip anesthesiologists with the new knowledge and skills for the safe management of a difficult airway. Recent findings In addition to knowledge and expertise, human factors and nontechnical skills (NTS), including situational awareness, communication and team work, play an important role during difficult airway management and contribute to the outcome. Didactic sessions are useful to impart knowledge. Self-learning, interactive discussions, simulation and debrie...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Difficult airway management and training: simulation, communication, and feedback
We present the details of the Zurich Airway Training and Simulation program, which has been constantly updated to the actual state of knowledge and available equipment. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Safety and efficacy of epidural analgesia
This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. Recent findings Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia. The debate continues whether epidural analgesia leads to decreased complications and improved outcome. Noninferiority of alternative regional an...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Enhancing the quality and safety of the perioperative patient
Purpose of review Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced. Recent findings Our understanding of the relationship between preoperative preparation and postoperative outcomes has improved. There have also been recent developments in our understanding of how to construct useful cognitive aids and make the best use of checklists by understanding the cultural environment supporting their use. Postoperatively, the concept of ‘failure to rescue’ in the surgical patients ha...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Recent advances of simulation in obstetric anesthesia
Purpose of review Simulation training in obstetric anesthesia has become widespread in recent years. Simulations are used to train staff and trainees, assess and improve team performance, and evaluate the work environment. This review summarizes current research in these categories. Recent findings Simulation to improve individual technical skills has focused on induction of general anesthesia for emergent cesarean delivery, an infrequently encountered scenario by anesthesia trainees. Low- and high-fidelity simulation devices for the learning and practicing neuraxial and non-neuraxial procedures have been described, a...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Recent advances in perioperative glucose monitoring
This article will review previously established data and new developments in this field. Recent findings Several different methods exist to measure blood glucose levels in the perioperative setting, including central laboratory devices, blood gas analyzers, and point-of-care devices. However, it has been recommended that point-of-care devices not be used on ‘critically ill’ patients, which throws into question the common use of these devices perioperatively. Recently, the Centers for Medicare and Medicaid placed a moratorium on this recommendation, and these devices continue to be a staple in the perioperati...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

New advancements in spinal cord stimulation for chronic pain management
Purpose of review To update the recent development of spinal cord stimulation (SCS) technology in the management of chronic pain. Recent Findings Efficacy of SCS therapy has been significantly improved by the recent development of high frequency (HF-10 kHz) stimulation, burst stimulation, and dorsal root ganglion (DRG) stimulation. A few latest SCS modalities are in clinical trial. New approaches to guide lead placement and advances in surgical lead are introduced. Summary HF-10 SCS is free of paresthesia and associated with significantly better coverage of axial lower back pain. Burst stimulation invokes minimal...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Anesthesia information management: clinical decision support
Purpose of review Perioperative informatics tools continue to be developed at a rapid pace and offer clinicians the potential to greatly enhance clinical decision making. The goal of this review is to bring the reader updates on perioperative information management and discuss future research directions in the field. Recent findings Clinical decision support tools become more timely, accurate, and, in some instances, have been shown to improve patient outcomes. When correctly implemented, they are critical tools for optimization of perioperative care. Summary Perioperative informaticians continue to test new and in...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research

Are we fully utilizing the functionalities of modern operating room ventilators?
Purpose of review The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. Recent findings Piston ventilators have the advantages of delivering accurate tidal volume and certain flow compensation functions. Turbine ventilators have great ability of flow compensation. Ventilation modes are mainly volume-based or pressure-based. Pressure-bas...
Source: Current Opinion in Anaesthesiology - November 2, 2017 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Yandong Jiang and Merrick E. Miles Source Type: research