Airway management in the adult patient with an unstable cervical spine
Purpose of review
The ideal airway management of patients with unstable spinal injury presents a perennial challenge for anaesthesiologists. With competing interests, potentially catastrophic complications, and a scarcity of evidence to support common practices, it is an area rich with dogma and devoid of data. This review seeks to highlight recent evidence that improves our assurance that what we do to manage the airway in the unstable cervical spine is supported by data.
Recent findings
The increasing range of available technology for intubation provides important opportunities to investigate the superiority (...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Anesthesia and intraoperative neurophysiological spinal cord monitoring
Purpose of review
We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery.
Recent findings
In recent years, the use of IONM has increased significantly. It has deve...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Perioperative management considerations in patients taking prescribed psychoactive medications (including those for depression and Parkinson's disease)
Purpose of review
Given the number of drugs available in the anaesthetist's armamentarium, drug interactions need to be managed. This is particularly true of psychoactive medications which primarily act on the central nervous system, targeting neurotransmitter pathways often affected by anaesthetic agents. This review gives an overview of the potential interactions of commonly used psychoactive medications with anaesthetic agents and hence their perioperative considerations. As anaesthetists will already be very familiar with the benzodiazepines, they will not be discussed here. Electroconvulsive therapy will also not ...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Anesthetic management during transsphenoidal pituitary surgery
Purpose of review
Pituitary adenoma resections comprise a large proportion of intracranial tumor surgeries. This patient population is medically and physiologically complex and requires careful perioperative planning and management on the part of the anesthesiologist. This review will summarize anesthetic considerations for pre, intra, and postoperative management of patients undergoing transsphenoidal pituitary surgery.
Recent findings
An endoscopic approach is favored for patients undergoing transsphenoidal pituitary surgery. Hemodynamic monitoring is important to maintain cerebral perfusion and avoid risk of ...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Same day discharge for craniotomy
Purpose of review
Same-day protocols for craniotomy have been demonstrated to be feasible and safe. Its several benefits include decreased hospital costs, less nosocomial complications, fewer case cancellations, with a high degree of patient satisfaction. This paper reviews the most recent publications in the field of same-day discharge after craniotomy.
Recent findings
Since 2019, several studies on same-day neurosurgical procedures were published. Ambulatory craniotomy protocols for brain tumor were successfully implemented in more centers around the world, and for the first time, in a developing country. Addi...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Anesthesia for deep brain stimulation: an update
Purpose of review
Deep brain stimulation (DBS) is a rapidly expanding surgical modality for the treatment of patients with movement disorders. Its ability to be adjusted, titrated, and optimized over time has given it a significant advantage over traditional more invasive surgical procedures. Therefore, the success and popularity of this procedure have led to the discovery of new indications and therapeutic targets as well as advances in surgical techniques. The aim of this review is to highlight the important updates in DBS surgery and to exam the anesthesiologist's role in providing optimal clinical management.
Re...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Ketamine in depression and electroconvulsive therapy
Purpose of review
The antidepressant effect of subanesthetic doses of ketamine was recognized 20 years ago. This review briefly summarizes the current understanding of the antidepressant mechanisms and the available clinical research on the use of racemic ketamine and enantiomer esketamine for depression.
Recent findings
The antidepressant effect of subanesthetic doses of ketamine is currently considered to be predominantly mediated by improved neuroplasticity in cortico-limbic areas in the brain. Single dose of 0.5 mg/kg of ketamine infused intravenously over 40 min, or single intranasal dose of esketamine ...
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Editorial: Neuroanaesthesiology editorial
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Anthony R. Absalom Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - September 2, 2021 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Selective periarticular blocks for postoperative pain after hip and knee arthroplasty
Purpose of review
This review aims to provide an overview of selective periarticular blocks for postoperative pain after hip and knee arthroplasty and the current evidence for their use.
Recent findings
Most interventional analgesia techniques for hip and knee arthroplasty result in a motor block and muscle weakness. Therefore, these are not well suited for fast-track protocols. In contrast, selective pericapsular infiltration techniques provide selective joint sensory block without an associated motor block. This facilitates postoperative pain management and avoids impairing ambulation and early rehabilitation....
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARY Source Type: research
Getting hit by the bus around the world – a global perspective on goal directed treatment of massive hemorrhage in trauma
This article summarizes main principles in coagulation diagnostics and compares different strategies for treatment of massive hemorrhage after trauma in different regions of the world. How would a bleeding trauma patient be managed if they got hit by the bus in the United States, United Kingdom, Germany, Switzerland, Austria, Denmark, Australia, or in Japan?
Summary
There are multiple coexistent treatment standards for trauma-induced coagulopathy in different countries and different trauma centers. Most of them initially follow a protocol-based approach and subsequently focus on predefined clinical and laboratory ta...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research
Severe bleeding in the ICU
Purpose of review
Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only.
Recent findings
Recent public...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research
The multisystem inflammatory syndrome in children and its association to SARS-CoV-2
We describe the clinical presentation, diagnosis, and treatment recommendations.
Recent finding
To date, no randomized prospective studies have been published; recommendations are based on some observational studies, case reports, and expert opinions. The article provides an overview of the most important publications, presents the current results of the German Registry for PIMS and expert recommendations for treatment.
Summary
MIS-C PIMS is a new syndrome that is associated with a variety of virus infections, and also with SARS-CoV-2. The main characteristics are fever, multiple organ dysfunction due to a hy...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research
Fibrinogen in traumatic haemorrhage
This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage.
Recent findings
Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, ...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research
Prehospital administration of blood and plasma products
Purpose of review
Posttraumatic bleeding following major trauma is life threatening for the patient and remains a major global health issue. Bleeding after major trauma is worsened by trauma-induced coagulopathy (TIC). TIC consists of acute trauma coagulopathy and resuscitation coagulopathy. The early diagnosis and management of prehospital TIC management are challenging.
Recent findings
Concepts for early diagnosis and management of civilian prehospital TIC management are evolving. The feasibility of prehospital blood component as well as coagulation factor transfusion has been proven.
Summary
Due to dif...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Andrea U. Steinbicker Source Type: research
