A not so sweet scenario: impact of perioperative glucose control on regional anesthetic techniques for orthopedic surgery
Purpose of review Diabetes and hyperglycemia are well established risk factors for complications associated with common orthopedic surgeries. In some practice settings, these conditions are also viewed as contraindications to regional nerve catheters. In this article, we aim to present our approach to offering the benefits of this modality in a safe manner for patients with diabetes and even some with preexisting, localized infections. Recent findings Evidence suggests that reduction in opioids and avoidance of general anesthesia can be particularly beneficial for patients with diabetes and high blood sugar, who...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Review of pediatric hypercarbia and intraoperative management
Purpose of review Hypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. Recent findings Although physiological range in this patient population may not be fully understood, it is ...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

MAP 65-is it enough?
Purpose of review The purpose of this review is to look at the current evidence on the consequences of intraoperative hypotension and discuss improvements that can be implemented for its prevention. Recent findings Literature continues to supply convincing evidence that even brief periods of intraoperative hypotension are associated with increased perioperative morbidity and mortality. Recent randomized controlled trial showed intraoperative early use of vasopressor and maintaining blood pressure within tight ranges improves outcomes. Summary There should be a shift in paradigm in focusing on the preventi...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Early tracheostomy: on the cutting edge, some benefit more than others
Purpose of review The decision to undergo early tracheostomy in critically ill patients has been the subject of multiple studies in recent years, including several meta-analyses and a large-scale examination of the National in-patient Sampling (NIS) database. The research has focused on different patient populations, and identified common outcomes measures related to ventilation. At the crux of the new research is the decision to undergo an additional invasive procedure, mainly tracheostomy, rather than attempt endotracheal tube ventilation with or without early extubation. Notably, recent research indicates that neuro...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Sepsis and the microcirculation: the impact on outcomes
Purpose of review Advances in the treatment of septic shock have historically focused on resuscitation endpoints, mainly mean arterial pressure and cardiac output. As the definitions of sepsis and septic shock have shifted to focus on the diversity of causes of dysregulated host-response we have seen an emerging phenotype where tissue hypoxia persists despite adequate macrocirculatory parameters. Interest in the topic of microcirculation is re-emerging as validated bedside techniques for hemodynamic monitoring, such as video microscopes, are becoming available. We review the current understanding of how sepsis induced ...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Regional anesthesia and the acute pain service: compliance and controversies
Purpose of review The aims of this article are three-fold: first, to describe the necessary elements that result in accurate and compliant billing practice; second, to discuss billing in the context of new blocks and liposomal bupivacaine; and third, to gain a better understanding of compliance law. Recent findings Regional anesthesia techniques provide an appealing alternative to opioid medication for pain management. However, these techniques also increase the cost of care. As new peripheral and fascial plane blocks emerge, proper coding has become more complex. Summary Familiarity with documentation, b...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Perioperative acute kidney injury: impact and recent update
Purpose of review Acute kidney injury (AKI) is common in hospitalized patients and is a major risk factor for increased length of stay, morbidity, and mortality in postoperative patients. There are multiple barriers to reducing perioperative AKI – the etiology is multi-factorial and the diagnosis is fraught with issues. We review the recent literature on perioperative AKI and some considerations for anesthesiologists that examine the far-reaching effects of AKI on multiple organ systems. Recent findings This review will discuss recent literature that addresses the epidemiology, use of novel biomarkers in risk ...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Diversity of anesthesia workforce – why does it matter?
Purpose of review Although recent census demonstrates that women comprise 50.8% and ethnic minority groups collectively consist of 42.1% of the US population, the field of anesthesiology still demonstrates disparity in representation and health outcomes across race, ethnicity, and gender. In addition, the growing percentage of people that identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) compounded with limited representation among providers of their care can augment existing disparate outcomes within this community. Recent findings Compared to male colleagues, women physicians across all specia...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Examining intersectionality in anesthesiology training, academics, and practice
Purpose of review Intersectionality, or the overlapping nature of social categorizations, such as race, class, and gender, creates interdependent systems of discrimination, disadvantage, and health disparities. The present review examines common shortcomings to diversity management, and proposes targeted improvement frameworks for anesthesiology departments that would offer competitive advantage in training, hiring, and retention, and improved care delivery aimed toward reducing health disparities. Recent findings Studies highlight that physicians equipped to care for diverse populations enhance patient–doctor...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Professionalism: COVID-19 made me do it!
Purpose of review COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct. Recent findings Multiple ethical questions arose as the COVID-19 pandemic ravaged globally, including physician obligations in a pandemic, allotment of personal protective equipment, care of unvaccinated patients, discern between evidence-based and unreliable information, addressing end-of-life wishes, implications of involving medical students in a public health crisis, and finally physician burnout aggravated by a pandemic. Summary There...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Extracorporeal cardiopulmonary resuscitation: is it futile?
Purpose of review Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment modality used to restore end-organ perfusion in the setting of refractory cardiac arrest in patients receiving cardiopulmonary resuscitation (CPR). Despite advances in medicine, survival from cardiac arrest remains low with conventional CPR. The body of literature relating to ECPR is limited to retrospective studies and case series, with data that are inconsistent. Routine use of ECPR is not currently endorsed by the American Heart Association. Recent findings In several single-center retrospective studies, ECPR was associated w...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

Editorial: Think again
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOMES: Edited by Alice A. Tolbert Coombs Source Type: research

The efficacy of apneic oxygenation to prevent hypoxemia during rapid sequence intubation in trauma patients
Purpose of review Rapid and effective airway management is priority for trauma patients. Trauma patients are often at an increased risk of experiencing hypoxia, and thus at increased risk of morbidity and mortality. Apneic oxygenation has been widely debated but has been reported to provide benefit in terms of increased peri-intubation oxygen saturation and decreased rates of desaturation. This review aims to evaluate the current literature on the efficacy of apneic oxygenation in the setting of rapid sequence intubation (RSI) in trauma patients. Recent findings Two prospective studies published this year, demon...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research

Advances in hemorrhage control resuscitation
Purpose of review Despite significant advances in trauma management over the last twenty years, uncontrolled hemorrhage remains the leading cause of preventable death in trauma. We review recent changes affecting hemorrhage control resuscitation. Recent findings Early blood product usage has become well established as a standard of care in trauma hemorrhage control. To enable this, low titer group A liquid plasma and group O whole blood are increasingly utilized. Single donor apheresis platelets have now replaced pooled donor platelets in the USA and are often pathogen reduced, which has implications for trauma ...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research

Surgical rib fixation in traumatic rib fractures: is it warranted?
Purpose of review Traumatic chest wall injuries and rib fractures remain a prevalent injury. Despite many advances, these injuries result in high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) is increasing in utilization with expanding indications. Recent studies have demonstrated that many patients may benefit from surgical intervention. Recent findings Over the past 20 years the indications and timing of SSRF has evolved. Once reserved mainly for the most extreme of injuries, expanding indications demonstrate that even minimally injured patients may benefit from intervention regarding...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research