Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education
Purpose of review The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. Recent findings Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistic...
Source: Current Opinion in Anaesthesiology - March 7, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Helicopter air ambulance services
Purpose of review Helicopter air ambulances are an integral component of modern trauma care, and are able to transport patients to facilities with greater capabilities, extract injured patients from hostile terrain, and speed transport to a trauma center. Recent findings HAA transport does not reduce the total time required to transport a patient, but it does reduce the time that the patient is between healthcare facilities. Factors that have been suggested to improve outcomes for trauma patients include the availability of advanced interventions, skilled personnel, speed, and trauma center access. Despite their poten...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Burn injury and blood transfusion
Purpose of review Blood transfusion is ubiquitous in major burn injury. The present article describes recent research findings directly impacting blood transfusion strategies in major burn injury both in the operating room and the ICU. Recent findings Transfusion strategies have been the focus of recent burn investigations. First, a randomized prospective trial encompassing both the ICU and operating room reported that a restrictive red blood cell transfusion threshold (7 g/dl) had equivalent outcomes to a traditional threshold (10 g/dl) for burns more than 20% in terms of mortality, infection, length of stay, dur...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Transfusion reactions and cognitive aids
Purpose of review Although the overall safety of blood transfusion is high, adverse events do still occur. Much research on transfusion reactions was done in nonperioperative patients. Fortunately, important contributions to the perioperative literature have been made in the last several years, specifically in the areas of transfusion-associated circulatory overload and transfusion-related acute lung injury (TRALI). Recent findings An unfavorable reaction occurs in as many as 1% of transfusions overall, although the risk of death with each unit given is between 0.002 and 0.0005%. Specific, modifiable factors exist, ho...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Extra corporeal membrane oxygenation in the critical trauma patient
Purpose of review The purpose of this review is to describe recent evidence regarding the use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for severe cardiac or respiratory failure in patients with trauma. The characteristics of this cohort of patients, including the risk of bleeding and the need for systemic anticoagulation, are generally considered as relative contraindications to ECMO treatment. However, recent evidence suggests that the use of ECMO should be taken in consideration even in this group of patients. Recent findings The recent findings suggest that venous–venous ECMO can be fe...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Thoracic trauma in military settings: a review of current practices and recommendations
Purpose of review To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. Recent findings Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems. Although Tactical Combat Casualty Care protocol recommends th...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Resuscitative endovascular balloon occlusion of the aorta: an option for noncompressible torso hemorrhage?
Purpose of review Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted. Recent findings T...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Reversing anticoagulation in the hemorrhaging patient
Purpose of review Anticoagulants in general, but especially the relatively new direct oral anticoagulants and platelet inhibitors, pose a great challenge for physicians in the hemorrhaging patient. The aim of the present review is to provide an overview on recent studies dealing with the reversal of anticoagulation in the hemorrhaging patient and to describe our therapeutic emergency strategy for those patients. Recent findings A specific antidote for dabigatran is already on the market and antidotes for the direct and indirect factor Xa inhibitors are in development. Moreover, bleeding under platelet inhibitors remai...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

The use of new procoagulants in blunt and penetrating trauma
Purpose of review Uncontrolled bleeding in trauma secondary to a combination of surgical bleeding and trauma-induced complex coagulopathy is a leading cause of death. Prothrombin complex concentrates (PCCs), recombinant activated factor seven (rFVIIa) and recombinant human prothrombin act as procoagulants by increasing thrombin generation and fibrinogen concentrate aids stable clot formation. This review summarizes the current evidence for procoagulant use in the management of bleeding in trauma, and data and evidence gaps for routine clinical use. Recent findings Retrospective and prospective studies of PCCs (±...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Corey Scher Source Type: research

Cheaper drugs and techniques to fulfill chief executive officer perspectives – any choices?
Purpose of review Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. Recent findings Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a ‘no’ for an answer, doctors may be able to argue for a change – even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugamma...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research

Resource allocation in ICU: ethical considerations
Purpose of review Increasing scarcity of resources on the background of ever improving medical care and prolonged life expectancy has placed a burden on all aspects of health care. In this article we examine the current problems with resource allocation in intensive care and question whether we can find guidance on appropriate resource allocation through ethical models. Recent findings The problem of fair and ethical resource allocation has perpetually plagued health care. Recent work has looked at value for money, benefits of therapies and how we define futility, but these still fall victim to the same problems that ...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research

Withholding or withdrawing life support versus physician-assisted death: a distinction with a difference?
Purpose of review Withholding or withdrawing life-sustaining therapy is generally differentiated from physician-assisted suicide or euthanasia based on the distinction between intention and foresight. We reviewed the literature surrounding the validity of this distinction. Recent findings Many physicians from different specialties express a perceived distinction between intention and foresight. The distinction between intention and foresight differs from the morally irrelevant distinction between doing and allowing. Intention and foresight may be distinguished by their opposing directions of fit between world and mind...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research

Nonstandard do-not-resuscitate orders
Purpose of review Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. Recent findings Studies show both providers and patients confuse the meaning and implication of DNR orders. In the United States, out-of-hospital DNR orders are legislated at the state level. Most states standardized out-of-hospital DNR orders so caregivers can immediately recognize and accept the order and act on its behalf. These out-of-hospital orders are c...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research

Ethical lessons learned and to be learned from mass casualty events by terrorism
Purpose of review The world has seen a major upturn in international terror awareness. Medicine has had to respond. In addition to the unique physical and mental injuries caused by terror which require special clinical attention, so too terror represents a challenge for medicine from an ethics perspective. Recent findings Several responses in the literature over the past few years have attempted to reflect where the battlefront of ethical dilemmas falls. These include issues of resource allocation, triage, bioterror, the therapeutic relationship with terrorists, dual loyalty, and challenges in the role in the promotio...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research

The ethics of treating family members
Purpose of review Many medical professionals receive requests from family and friends asking for medical advice and treatment. But should medics treat their family? Ethically can we treat, or refuse to treat, family members? This is a common ethical challenge that most doctors face during their career and there is limited evidence available. By examining ethical principles, we aim to answer these questions and provide a framework that will guide decision making in this area. Recent findings There is a paucity of evidence available. Many ethical systems exist and have been discussed since ancient Greece but in recent y...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Hartmut Buerkle Source Type: research

Sepsis - What's new in 2019?
Purpose of review Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics. Recent findings Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation. Angiotensin II is investigated for reversing vasodilatory shock. The role of cap...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Glucose control in the ICU
Purpose of review Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. Recent findings Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy a...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Noninvasive ventilation versus oxygen therapy in patients with acute respiratory failure
Purpose of review High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. Recent findings Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those wi...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

The effectiveness of noise interventions in the ICU
Purpose of review Excessive noise has direct adverse physiological and psychological effects, and may also have indirect negative health consequences by reducing sleep quality and quantity. This review presents a synthesis of the epidemiology of noise in the ICU, and the potential interventions designed to attenuate noise and protect patients. Recent findings Noise increases cortisol release, oxygen consumption, and vasoconstriction. ICU noise levels are excessive throughout the 24-h cycle, irrespective of level of intervention or whether the patient is in a side room or open ward. Direct measurement suggests that noi...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Time-efficient, goal-directed, and evidence-based teaching in the ICU
Purpose of review Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. Recent findings Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education
Purpose of review The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. Recent findings Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistic...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Intensivist staffing and outcome in the ICU: daytime, nighttime, 24/7?
Purpose of review Many hospitals, particularly large academic centers, have begun to provide 24-h in-house intensive care attending coverage. Proposed advantages for this model include improved patient care, greater provider, nursing and patient satisfaction, better communication, and greater cost-effectiveness. This review will evaluate current evidence with respect to 24/7 coverage, including patient outcomes, cost-effectiveness, and impact on training/education. Recent findings Evidence surrounding 24-h intensivist staffing has been mixed. Although a subset of studies suggest a possible benefit to 24-h intensivist ...
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Editorial: ‘May you live in interesting times’: blessing or curse for an intensivist?
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marek Brzezinski Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - February 28, 2019 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

General versus spinal anesthesia for the elderly hip fractured patient
Purpose of review There is an urge to improve care for patients with hip fracture. The present review will compare the efficacy of spinal versus general anesthesia for patients requiring hip fracture surgery. Recent findings The present review gives an overview with particular emphasis on literature published during the past 24 months. Summary So far, no clear evidence form randomized trials exists to identify the best anesthesia technique for hip fracture surgery. However, several large-scale pragmatic trials are ongoing and will provide future guidance. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Rainer Kiefmann Source Type: research

Prehabilitation is better than cure
Purpose of review With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of ‘prehabilitation’ with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. Recent findings Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various ...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Rainer Kiefmann Source Type: research

Neuromonitoring in the elderly
Purpose of review To summarize recent recommendations on intraoperative electroencephalogram (EEG) neuromonitoring in the elderly aimed at the prevention of postoperative delirium and long-term neurocognitive decline. We discuss recent perioperative EEG investigations relating to aging and cognitive dysfunction, and their implications on intraoperative EEG neuromonitoring in elderly patients. Recent findings The incidence of postoperative delirium in elderly can be reduced by monitoring depth of anesthesia, using an index number (0–100) derived from processed frontal EEG readings. The recently published European...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Rainer Kiefmann Source Type: research

Biomarkers and postoperative cognitive function: could it be that easy?
Purpose of review Neurocognitive dysfunction after surgery is highly relevant in the elderly. The multifactorial manner of this syndrome has made it hard to define an ideal biomarker to predict individual risk and assess diagnosis and severity of delirium [postoperative delirium (POD)] and subsequent postoperative cognitive decline (POCD). This review summarizes recent literature on blood biomarkers for POD/POCD. Recent findings Markers for delirium have been searched for in the cerebrospinal fluid to examine the pathologic cascade. However, cerebrospinal fluid cannot be easily obtained in the perioperative setting. T...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Rainer Kiefmann Source Type: research

Pain therapy for the elderly patient: is opioid-free an option?
Purpose of review Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. Recent findings A comprehensive pain assessment is a prerequisite for effective pain management. However, this can be a major challenge in patients who are unable to communicat...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Rainer Kiefmann Source Type: research

Sodium-glucose cotransporter-2 inhibitors: an overview and perioperative implications
Purpose of review Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors. Recent findings Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden. In addition, there is a reduction in HbA...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Spinal cord perfusion protection for thoraco-abdominal aortic aneurysm surgery
Purpose of review Spinal cord ischemia (SCI) is a devastating complication after open or endovascular aortic repair for thoracoabdominal aortic disease. The underlying pathogenesis is not fully understood but appears multifactorial. Multiple spinal cord protection strategies and monitoring techniques are currently utilized with variable results seen. The purpose of this review is to summarize important and recent findings related to cause, monitoring and impact of multiple spinal cord protection strategies. Recent findings Recent data suggests collateral blood flow as the major determinant of spinal cord perfusion ins...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Role of anesthesiologists in managing perioperative anemia
Purpose of review Anemia can contribute negatively to a patient‘s morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings. Recent findings Patient Blood Management and standards for the management and treatment of anemia have been established worldwide. Various logistic settings and approaches are possible. With a special focus on cardiovascular anesthesia, intravenous iron is a therapeutic option in the preoperative setting. Autologous blood salvage is a standard procedu...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Pulse pressure and perioperative stroke
Purpose of review Central pulse pressure (PP), a marker of vascular stiffness, is a novel indicator of risk for perioperative morbidity including ischemic stroke. Appreciation for the mechanism by which vascular stiffness leads to organ dysfunction along with understanding its clinical detection may lead to improved patient management. Recent findings Vascular stiffness is associated with increased mortality and neurologic, cardiac, and renal injury in nonsurgical and surgical patients. Left ventricular hypertrophy and diastolic dysfunction along with microcirculatory changes in the low vascular resistance, high blood...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

Incremental value of noncerebral somatic tissue oxygenation monitoring for patients undergoing surgery
Purpose of review There is increasing interest in the use of noncerebral somatic tissue oxygen saturation (SstO2) monitoring on the basis of near-infrared spectroscopy in patients undergoing surgery or residing in intensive care unit. The relevant question is whether SstO2 monitoring can improve the quality of care. In this article, we reviewed the clinical application of SstO2 monitoring in acute care, focusing on its use in patients undergoing surgery. Recent findings Multiple small cohort studies conducted on pediatric patients reported close associations of SstO2 measurements over different regions such as the spl...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Manuel L. Fontes Source Type: research

High-flow nasal cannula oxygen therapy in patients undergoing thoracic surgery: current evidence and practice
Purpose of review Patients undergoing thoracic surgery are at high risk for pulmonary and extra pulmonary complications, and may develop impairment of gas exchange during surgery and in the postoperative period. This review focuses on the potential benefits of high-flow nasal cannula (HFNC) oxygen therapy in those patients. Recent findings HFNC oxygen therapy can be used pre, intra and postoperatively. However, evidence for the use of HFNC oxygen therapy is still limited. Most trials investigated the effects of HFNC oxygen therapy in the postoperative period only, with promising beneficial effects. Preoperative HFNC o...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Precise anesthesia in thoracoscopic operations
Conclusion The determining factors in designing a precise anesthesic for VATS operations involve consensus on patients’ tolerance of the associated side effects, the best practice or techniques for surgery and anesthesia, the required postoperative support, and the care team's experience. (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Extravascular lung water monitoring for thoracic and lung transplant surgeries
Purpose of review Excessive accumulation of extravascular lung water (EVLW) resulting in pulmonary edema is the most feared complication following thoracic surgery and lung transplant. ICUs have long relied on chest radiography to monitor pulmonary status postoperatively but the increasing recognition of the limitations of bedside plain films has fueled development of newer technologies, which offer earlier detection, quantitative assessments, and can aide in preoperative screening of surgical candidates. In this review, we focus on the emergence of transpulmonary thermodilution (TPTD) and lung ultrasound with a focus on...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Preoperative rehabilitation for thoracic surgery
Purpose of review Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways. Recent findings Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer. Preoperative exercise programmes may improve cardiorespiratory reserve and reduce perioperative complications. Additional benefits may be achieved throu...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

A surgical perspective of ERAS guidelines in thoracic surgery
Purpose of review Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization. Recent findings Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative ...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Examination of the enhanced recovery guidelines in thoracic surgery
Purpose of review Enhanced Recovery After Thoracic Surgery (ERATS) has gained momentum over the past few years, although the evidence base and expert recommendations lag behind other specialties. This review will present and examine key points from the first guidelines for enhanced recovery after lung surgery, released in 2018, jointly sponsored by the European Society of Thoracic Surgeons and the Enhanced Recovery After Surgery Society. Recent findings The recently released guidelines present core components of enhanced recovery as they pertain to lung resection surgery. Although evidence is still sparse in some area...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Delayed recovery following thoracic surgery: persistent issues and potential interventions
Purpose of review Lung and esophageal surgery remain a curative option for resectable cancers. However, despite advances in surgical and anesthesia practices, the inclusion of patients with comorbidities that would have previously not been offered curative resection presents additional concerns and challenges. Recent findings Perioperative complication rates remain high and prolonged and/or painful recovery are common. Further, many patients face a permanent decline in their functional status, which negatively affects their quality of life. Examination of the variables associated with high complications following thor...
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Editorial: Enhanced recovery in thoracic surgery: can fuzzy logic bring clear results?
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 8, 2019 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research

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