Use of cannabis and cannabinoids in palliative care setting
Purpose of review Cannabis products have been used for various ailments since ancient times. But their use diminished in the medical community due to the legal and social concerns of substance abuse. With evolving evidence of their use in alleviating various symptoms, resurgence of interest in their medicinal use is seen in the past decade. Recent findings Clinical evidence for cannabis products in treating various ailments has been far from robust. Their use is based on anecdotal and low-quality evidence. This review attempts to revisit the recent medical literature available on the merits and demerits of cannabinoid...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Salahadin Abdi Source Type: research

Anesthetic considerations in medical cannabis patients
Purpose of review Growing numbers of patients, consuming cannabinoids admitted to surgery, create a challenge to anesthesia providers. This review provides a summary of recent literature related to cannabis and anesthesia, with specific recommendations to the anesthetic management of medical cannabis consumers. Recent findings At present, cannabis has found its way to public consensus in many countries and is penetrating slower to different medical fields. We relate and discuss recent findings investigating effects of cannabis consumption on the various aspects including perioperative measures, post-operative pain, PO...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Salahadin Abdi Source Type: research

Update on cannabis and cannabinoids for cancer pain
Purpose of review The prevalence of cancer pain will continue to rise as pain is common among the survivorship and general cancer population. As interest in cannabis and cannabinoids for medicinal use including pain management continues to rise, there is growing need to update and review the current state of evidence for their use. The literature was searched for articles in English with key words cannabis, cannabinoids, and cancer pain. The sources of articles were PubMed, Embase, and open Google search. Recent findings In a double-blind randomized placebo-controlled trial including a 3-week treatment period of nabix...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Salahadin Abdi Source Type: research

Editorial: Cannabis and cannabinoids for pain: a long way to go (or not): time will tell
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: PAIN MEDICINE: Edited by Salahadin Abdi Source Type: research

Measuring and monitoring perioperative patient safety: a basic approach for clinicians
Purpose of review Recent research points to considerable rates of preventable perioperative patient harm and anaesthesiologists’ concerns about eroding patient safety. Anaesthesia has always been at the forefront of patient safety improvement initiatives. However, factual local safety improvement requires local measurement, which may be afflicted by barriers to data collection and improvement activities. Because many of these barriers are related to mandatory reporting, the focus of this review is on measurement methods that can be used by practicing anaesthesiologists as self-improvement tools, even independently ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

The Bowtie diagram: a simple tool for analysis and planning in anesthesia
Purpose of review The purpose is to show the advantages of a Bowtie diagram as a versatile tool for displaying and understanding the evolvement and management of critical incidents. Recent findings The Bowtie diagram has been used recently in anesthesia to depict critical incidents having been used in high-risk industries for several decades. This diagram displays the progression from latent factors to potential harm in five steps. Summary The Bowtie diagram combines the features of a fault tree and an event tree with the adverse event, known as the Top Event separating the two sections. The fault tree is similar i...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

Advances in anesthesia education: increasing access and collaboration in medical education, from E-learning to telesimulation
Purpose of review The landscape of medical education continues to evolve. Educators and learners must stay informed on current medical literature, in addition to focusing efforts on current educational trends and evidence-based methods. The present review summarizes recent advancements in anesthesiology education, specifically highlighting trends in e-learning and telesimulation, and identifies possible future directions for the field. Recent findings Websites and online platforms continue to be a primary source of educational content; top websites are more likely to utilize standardized editorial processes. Podcasts ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

Maternal safety: recent advances and implications for the obstetric anesthesiologist
This article reviews recent advances in maternal safety, highlighting those of particular relevance to anesthesiologists. Recent findings Cardiovascular and other chronic medical conditions contribute to an increasing number of maternal deaths. Anesthetic complications associated with general anesthesia are decreasing, but complications associated with neuraxial techniques persist. Obstetric early warning systems are evolving and hold promise in identifying women at risk for adverse intrapartum events. Postpartum hemorrhage rates are rising, and rigorous evaluation of existing protocols may reveal unrecognized deficienc...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

Automation failures and patient safety
Purpose of review The goal of automation is to decrease the anesthesiologist's workload and to decrease the possibility of human error. Automated systems introduce problems of its own, however, including loss of situation awareness, leaving the physician out of the loop, and training physicians how to monitor autonomous systems. This review will discuss the growing role of automated systems in healthcare and describe two types of automation failures. Recent findings An automation surprise occurs when an automated system takes an action that is unexpected by the user. Mode confusion occurs when the operator does not un...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

Current state of noninvasive, continuous monitoring modalities in pediatric anesthesiology
Purpose of review The last decades, anesthesia has become safer, partly due to developments in monitoring. Advanced monitoring of children under anesthesia is challenging, due to lack of evidence, validity and size constraints. Most measured parameters are proxies for end organ function, in which an anesthesiologist is actually interested. Ideally, monitoring should be continuous, noninvasive and accurate. This present review summarizes the current literature on noninvasive monitoring in noncardiac pediatric anesthesia. Recent findings For cardiac output (CO) monitoring, bolus thermodilution is still considered the go...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

Advances in airway management and mechanical ventilation in inhalation injury
Purpose of review Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions. Recent findings Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscop...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: TECHNOLOGY, EDUCATION AND SAFETY: Edited by Keith J. Ruskin Source Type: research

Patient-reported outcomes for ambulatory surgery
Purpose of review To discuss the importance of validated tools that measure patient-reported outcomes and their use in ambulatory surgery. Recent findings Sustained increases in ambulatory surgical care reflect advances in surgical techniques and perioperative anaesthetic care. Use of patient-reported outcomes allows identification of minor adverse events that are more common in this population compared with traditional endpoints such as mortality. Variability in reported outcomes restricts research potential and limits the ability to benchmark providers. The standardized endpoints in perioperative medicine initiative...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Peripheral nerve blockade and novel analgesic modalities for ambulatory anesthesia
Purpose of review Despite peripheral nerve blockade offering analgesic benefits and improving patient satisfaction, it has not been well adopted in ambulatory anesthesia. In this review, we aim to summarize the evidence underlying peripheral nerve blockade, local anesthetic adjuncts, continuous peripheral nerve blockade and novel analgesic modalities, with the objective to provide recommendations on postoperative analgesia optimization after peripheral nerve blockade in an ambulatory setting. Recent findings Barriers to the widespread use of peripheral nerve blockade in ambulatory anesthesia could include lack of educ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Procedure-specific and patient-specific pain management for ambulatory surgery with emphasis on the opioid crisis
Purpose of review Postoperative pain is frequent while, on the other hand, there is a grooving general concern on using effective opioid pain killers in view of the opioid crisis and significant incidence of opioid abuse. The present review aims at describing nonopioid measures in order to optimize and tailor perioperative pain management in ambulatory surgery. Recent findings Postoperative pain should be addressed both preoperatively, intraoperatively and postoperatively. The management should basically be multimodal, nonopioid and procedure-specific. Opioids should only be used when needed on top of multimodal nonop...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Spinal anesthesia for ambulatory surgery: current controversies and concerns
Purpose of review General anesthesia is a popular choice for ambulatory surgery. Spinal anesthesia is often avoided because of perceived delays due to time required to administer it and prolonged onset, as well as concerns of delayed offset, which may delay recovery and discharge home. However, the reports of improved outcomes in hospitalized patients undergoing total joint arthroplasty have renewed the interest in spinal anesthesia. This review article critically assesses the role of spinal anesthesia in comparison with fast-track general anesthesia for the outpatient setting. Recent findings The purported benefits o...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Nulla Per Os (NPO) guidelines: time to revisit?
Purpose of review Preoperative fasting guidelines are generalized to elective procedures and usually do not distinguish between the ambulatory and inpatient setting. Prevalence of aspiration is low while prolonged preoperative fasting is common clinical reality. Recently, changes in preoperative fasting guidelines have been widely discussed. Recent findings Rates of prolonged clear fluid fasting (>4 h) prior to surgery are reported in up to 80% of patients with mean fasting duration of up to 16 h and beyond. Prolonged fasting may result in adverse effects such as intraoperative hemodynamic instability, postoper...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Preoperative assessment and optimization of cognitive dysfunction and frailty in the ambulatory surgical patient
Purpose of review The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the asses...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

The high-risk patient for ambulatory surgery
This article describes the processes for identifying high-risk patients at the time of ambulatory procedure scheduling, enabling the implementation of multidisciplinary collaborative pathways for prehabilitation and optimization, allowing for risk mitigation and improvement in outcomes. This review is particularly relevant because of the current proliferation of ambulatory surgery with more complex procedures being performed on an outpatient basis on patients who may be American Society of Anesthesiologists Physical Status 3 or greater. Recent findings Increased longevity and rising prevalence of obesity have resulted i...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

High-risk surgical procedures and semi-emergent surgical procedures for ambulatory surgery
Purpose of review This review evaluates more complex surgical procedures to see whether they might be suitable for ambulatory surgery. Operations that have shown an increasing daycase rate in England include thyroidectomy, joint arthroplasty, spinal surgery and hysterectomy, and these procedures are evaluated. Similarly, there have been recent developments in the management of nonelective ambulatory surgery with more timely throughput and home discharge for suitable patients. Recent findings Caveats on patient selection with the development of focussed educational programmes about the proposed operation have assisted ...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Enhanced recovery pathways for ambulatory surgery
Purpose of review Implementation of enhanced recovery pathways have allowed migration of complex surgical procedures from inpatient setting to the outpatient setting. These programs improve patient safety and patient-reported outcomes. The present article discusses the principles of enhanced recovery pathways in adults undergoing ambulatory surgery with an aim of improving patient safety and postoperative outcomes. Recent findings Procedure and patient selection is one of the key elements that influences perioperative outcomes after ambulatory surgery. Other elements include optimization of comorbid conditions, patien...
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Girish P. Joshi Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - October 29, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Has the future arrived? Liposomal bupivacaine versus perineural catheters and additives for interscalene brachial plexus block
Purpose of review Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself. Recent findings Perineural infusion of local anesthetics with interscalene catheters provides superior pain relief with reduction of postoperative op...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Wrong-site nerve blocks: evidence-review and prevention strategies
Purpose of review There has been increasing attention to wrong site medical procedures over the last 20 years. This review aims to provide a summary of the current understanding and recommendations for the prevention of wrong-site nerve blocks (WSNB). Recent findings Various procedural, patient, practitioner, and organizational factors have been associated with the risk of WSNB. Recent findings have suggested that the use of a checklist is likely to reduce the incidence of WSNB. However, despite the widespread use of preprocedural checklists, WSNB continue to occur at significant frequency. This may be due to the inab...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Current understanding of the fascial plane blocks for analgesia of the chest wall: techniques and indications update for 2020
Purpose of review Thoracic myofascial plane blocks have gained popularity because of their ease of performance and relative safety. This review highlights current research demonstrating the efficacy of these blocks for specific surgical procedures and provides a brief description of how these techniques are performed. Recent findings Fascial plane blocks of the thorax and chest wall have been shown to be beneficial in providing perioperative analgesia for a variety of surgical procedures. Studies discussed in this review compare thoracic fascial plane blocks to systemic analgesia alone, contrast these novel methods of...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic
The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise. Recent findings In the last 18 months, study findings on various diaphragm-sparing regional anesthesia techniques have demonstrated comparable block analgesic effectivity with a variable extent of phrenic nerve paralysis. The impact of hemi-diaphragmatic function impairment on clinical outcomes is yet to be established. Summary Existing diaphragm...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Education and training in ultrasound-guided regional anaesthesia and pain medicine
Purpose of review Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years. Recent findings Twenty-two articles were identified, investigating nine out of the 13 top-ranked research topics in education and training in regional anaesthesia. Research topics addressed by these articles included prerotation simulation, deliberate practice combined with formative assessment tools, validation of assessment tool...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research

Postoperative delirium: why, what, and how to confront it at your institution
Purpose of review The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions. Recent findings There are few areas of consensus, backed by strong expe...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Interventions to improve perioperative neurologic outcomes
Purpose of review Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common perioperative neurologic complications. We will also discuss strategies to help prevent and mitigate these complications for our patients. Recent findings There are several strategies the anesthesiologist can undertake to prevent or treat conditions, such as perioperative neurocognitive disorders, spinal cord ischemia, perioperative stroke, and postoperative visual loss. Summary A thorough understanding of threats to patients’ neurol...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Prospects of molecular hydrogen in perioperative neuroprotection from basic research to clinical application
Purpose of review The current systematic review summarizes recent, basic clinical achievements regarding the neuroprotective effects of molecular hydrogen in distinct central nervous system conditions. Recent findings Perioperative neuroprotection remains a major topic of clinical anesthesia. Various gaseous molecules have previously been explored as a feasible therapeutic option in neurological disorders. Among them, molecular hydrogen, which has emerged as a novel and potential therapy for perioperative neuroprotection, has received much attention. Summary Fundamental and clinical evidence supports the antioxidan...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Cognitive declines after perioperative covert stroke: Recent advances and perspectives
Purpose of review With the aging of the population, there are increasing number of aged patients who require surgical interventions. Perioperative covert stroke is emerging as an important health threat and social burden that could affect patients’ long-term neurological outcomes. Recent findings Recent findings of the association between perioperative covert stroke with long-term cognitive declines of surgical patients highlighted the significance of the silent cognitive function killer—perioperative covert stroke. Considering the devastating long-term consequence of the asymptomatic covert stroke, early ...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Intraoperative hypotension and neurological outcomes
Purpose of review Intraoperative hypotension (IOH) may render patients at a risk of cerebral hypoperfusion with decreasing cerebral blood flow (CBF), and lead to postoperative neurological injury. On the basis of the literature in recent years, this review attempts to refine the definition of IOH and evaluate its impact on neurological outcomes. Recent findings Although both absolute and relative blood pressure (BP) thresholds, with or without a cumulative period, have been used in collective clinical studies, no definitive threshold of IOH has been established for neurological complications, including perioperative s...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Anesthesia and the brain after concussion
Purpose of review To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. Recent findings Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be ...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Ketamine: a versatile tool for anesthesia and analgesia
Purpose of review Ketamine has been used for decades for a variety of indications. Beyond the historical benefits and effects of ketamine, newer developments have occurred worthy of an update. This review will discuss common uses and indications for ketamine in the perioperative setting, as well as highlight newer indications in recent years. Recent findings Multiple studies have examined the use of ketamine in a variety of environments, as ketamine has become more popular in emergency rooms and ICUs. Ketamine may be particularly beneficial in management of burn patients, who often require multiple procedures over the...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Double standard: why electrocardiogram is standard care while electroencephalogram is not?
Purpose of review Major adverse cardiovascular and cerebrovascular events (MACCE) significantly affect the surgical outcomes. Electrocardiogram (ECG) has been a standard intraoperative monitor for 30 years. Electroencephalogram (EEG) can provide valuable information about the anesthetized state and guide anesthesia management during surgery. Whether EEG should be a standard intraoperative monitor is discussed in this review. Recent findings Deep anesthesia has been associated with postoperative delirium, especially in elderly patients. Intraoperative EEG monitoring has been demonstrated to reduce total anesthesia drug...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?
Purpose of review Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment? Recent findings There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although musc...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research

Editorial introduction
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Maternal morbidity: how to reduce it
Purpose of review Internationally there has been increased interest in maternal morbidity; both as a strategy to reduce maternal deaths and also because of the significant impact on a woman's life as a result of suffering from maternal morbidity. The present review will evaluate the current knowledge of, and strategies to reduce maternal morbidity. Recent findings The study of maternal morbidity and how to reduce it has been hampered for many years by the lack of a standard approach to measurement and evaluation. The World Health Organization has attempted to standardize the approach to maternal morbidity with the dev...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: SPECIAL COMMENTARY Source Type: research

Intubation outside of the operating room: new challenges and opportunities in COVID-19 era
Purpose of review Airway management in patients outside the operating room is associated with increased difficulties and risks, and the setting of the COVID-19 global pandemic adds another layer of complexity. Therefore, endotracheal intubation (ETT) of a patient who is presumptive COVID-19 or COVID-19 positive presents an additional challenge to an anesthesiologist. The aim of this review is to summarize the important principles of airway management outside of the operating room during the COVID-19 pandemic. Recent findings Several professional societies have formulated guidelines on airway management COVID-19 suspec...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Recent advances in nonoperating room anesthesia for cardiac procedures
Purpose of review The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there. Recent findings Recent literature indicates that many complicate...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anesthesia for patients with serious comorbidities
Purpose of review To provide aids to deal with increasing amount of several comorbidities in nonoperating room anesthesia (NORA). Recent findings New indexes for assessment of comorbidities are described and guidelines for the care of patients with obesity, obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), diabetes and COVID19 in NORA summarized. Summary In addition to ASA classification, such instruments as Charlson Comorbidity Index, Frailty Index, Surgical Complexity Score and Revised Cardiac Risk could supplement the prospective assessment of the risk of comorbidities. Using institutional p...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anaesthesia for elderly patients
Purpose of review The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required. Recent findings Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging,...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anesthesia for children
Purpose of review Nonoperating room anesthesia (NORA) cases performed in pediatric patients have increased over the past decade. It is imperative for the anesthesia provider to be familiar with the nuances of this environment and the myriad of cases to ensure delivery of safe and efficient care. Recent findings Though case volume has increased, sedative agents have largely remained unchanged. NORA sites must meet the same operating room standards and expectations of anesthesia established by the American Society of Anesthesiologists. Despite the increasing NORA volume and efforts to instill a similar culture of safety...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

The anesthesiologist and global climate change: an ethical obligation to act
Purpose of review Pollution and global warming/climate change contribute to one-quarter of all deaths worldwide. Global healthcare as a whole is the world's fifth largest emitter of greenhouse gases, and anesthetic gases, intravenous agents and supplies contribute significantly to the overall problem. It is the ethical obligation of all anesthesiologists to minimize the harmful impact of anesthesia practice on environmental sustainability. Recent findings Focused programs encouraging judicious selection of the use of anesthetic gas agents has been shown to reduce CO2 equivalent emissions by 64%, with significant cost ...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Risk stratification in patients undergoing nonoperating room anesthesia
Purpose of review A growing numerical and complexity of patients requiring nonoperating room anesthesia (NORA) necessitates a multidisciplinary approach of a highly experienced team in a highly technological setting of the cathlab or radiology suite. These requirements are even more magnified in the context of the coronavirus disease 2019 (COVID-19) pandemic. Recent findings This review describes the aspects of risk stratification both in adults and children with respect to patient morphology, airway management, cardiorespiratory function and finally future developments, which could beneficially interfere with imminen...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Interventional radiology for the obstetric patient
Purpose of review To discuss the recent results of the use of interventional radiology modalities treating postpartum hemorrhage (PPH). Recent findings PPH still is a leading cause of maternal morbidity and mortality. An important risk factor for the development of PPH is the placenta accreta spectrum. In patients with placenta accreta, we can use prophylactic balloon occlusion of the common or internal iliac artery or abdominal aorta to prevent PPH. Balloon occlusion of the abdominal aorta seems to ensure better results than balloon occlusion of the iliac artery in terms of blood loss, transfusion rate and hysterecto...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Is there a place for regional anesthesia in nonoperating room anesthesia?
Purpose of review General anesthesia and monitored anesthesia care (MAC) are the most widely used techniques in nonoperating room anesthesia (NORA). However, regional anesthesia is slowly finding viable applications in this field. This review aims at providing an update on the current practice of regional anesthesia techniques outside of the operating theatre. Recent findings Some anesthetic departments have implemented the use of regional anesthesia in novel applications outside of the operating room. In most cases, it remains an adjunct to general anesthesia but is sometimes used as the sole anesthetic technique. Th...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2
Purpose of review With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the ...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Terminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era
Purpose of review Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery. Recent findings We highlight key recent studies from the perioperative and informatics literature, placing each in the context of how it has, or how it may conceivably be applied to, improved NORA care. Summary There is significant opportunity for anaesth...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Standard procedures in nonoperating room anesthesia
This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. Recent findings Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced ri...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research

Procedural sedation outside the operating room
Purpose of review The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA. Recent findings Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, r...
Source: Current Opinion in Anaesthesiology - July 29, 2020 Category: Anesthesiology Tags: NONOPERATING ROOM ANESTHESIA: Edited by Janusz C. Andres Source Type: research