Inhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation
We describe recent evidence examining the benefits and harms associated with their use.
Recent findings
The environmental harms associated with desflurane and nitrous oxide likely outweigh any purported clinical benefits. Life cycle analyses are beginning to address the many gaps in our understanding, and informing choices made on all aspects of anaesthetic care. There is, however, an urgent need to move beyond the debate about anaesthetic technique A vs. B and focus also on areas such as sustainable procurement, waste management, pharmacological stewardship and joined-up solutions.
Summary
There is now compe...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research
Preoperative laboratory testing in elderly patients
Purpose of review
Preoperative testing in elderly patients is performed to examine the patient's current medical condition in the context of evaluating vulnerabilities and predicting postoperative complications to ensure that all functions recover before surgery. This review focused on preoperative laboratory tests in geriatric patients.
Recent findings
Preoperative complete blood count, electrolyte testing, and blood chemistry can predict postoperative complications. Preoperative elevated morning/evening salivary cortisol secretion ratio, C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratios, and...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research
Recent advances in understanding cognitive and behavioural alterations after early-in-life anaesthesia exposure and new mitigation/alternative strategies in preclinical studies
Purpose of review
Long-term behavioural and cognitive impairments after exposure to general anaesthetics during infancy is an intensely investigated and controversial topic. Recent clinical studies with prospective assessments associate exposure with long-term behavioural alterations rather than cognitive impairments. This review aims to provide an understanding of the long-term cognitive impairments and behavioural alterations found in recent animal studies and to summarize latest advances in strategies to protect against anaesthesia-induced developmental neurotoxicity (AIDN).
Recent findings
Preclinical studie...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research
Ready for a “breakthrough” with ketamine? A look at recent pharmacological insights!
Purpose of review
To update pharmacological insights on ketamine integrating information from different disciplines for developing steps to “breakthrough” approaches in clinical challenges.
Recent findings
Pharmacokinetic/pharmacodynamic (PK/PD) models have incorporated recirculation, ketamine metabolites, drug–drug interaction, and covariates such as age. Ketamine-induced relief from treatment-resistant depression has been explained by “disinhibition” of gamma-aminobutyric acid-ergic interneurons and synaptogenic mechanisms requiring neurotrophic signals. Neuroimaging/electroencephalographic investiga...
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Eberhard F. Kochs Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 29, 2021 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
The disruptive physician and impact on the culture of safety
Purpose of review
The disruptive physician is a growing problem in medicine. All too often, physician behavior negatively impacts the delivery of quality patient care. The hostile environment that certain behaviors create makes it difficult for team members advocate for their patients. It is imperative that physician practices develop and an understanding of how to identify the disruptive physician to maintain patient safety.
Recent findings
Disruptive physicians can damage team morale by creating a psychologically unsafe working environment. Healthcare organizations must be committed to ensuring that all team m...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARY Source Type: research
Myocardial injury after noncardiac surgery – an update
Purpose of review
After successfully reducing mortality in the operating room, the time has come for anesthesiologists to conquer postoperative complications. This review aims to raise awareness about myocardial injury after noncardiac surgery (MINS), its definition, diagnosis, clinical importance, and treatment.
Recent findings
MINS, defined as an elevated postoperative troponin judged to be due to myocardial ischemia (with or without ischemic features), occurs in up to one in five patients having noncardiac surgery and is responsible for 16% of all postoperative deaths within 30 days of surgery. New evidence...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Perioperative frailty: lessons learned and future directions
This article reviews current conceptual frameworks of frailty, references current literature and provides a practical approach to the preoperative frailty assessment with a focus on potential interventions.
Recent findings
A multipronged approach toward preoperative optimization should be used in patients with frailty syndrome. Oral protein supplementation and immunonutrition therapy can reduce complications in patients with malnutrition. Initiating a preoperative physical exercise regimen may mitigate frailty. Nonpharmacologic interventions to reduce preoperative anxiety and improve mood are effective, low-cost adj...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
How new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury
Purpose of review
Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evi...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Immunomodulators in anesthesia
Purpose of review
Anesthetics are known to have immunomodulatory effects. These can be detrimental, inducing immunosuppression and facilitating the development of opportunistic infections, especially when used at high doses, for prolonged periods, or in patients with preexisting immune deficiency; or beneficial, modulating the inflammatory response, particularly in critical illness and systemic hyperinflammatory states.
Recent findings
Anesthetics can have microbicidal properties, and both anti- and pro-inflammatory effects. They can act directly on immune cells as well as modulate immunity through indirect path...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Current concepts in the evaluation and management of preoperative anemia
Purpose of review
In the past years, patient blood management (PBM) has evolved to improve patient‘s care and safety. Anemia is one of the most common medical diseases in the world and is an independent risk factor for morbidity and mortality. Iron deficiency is the main cause for anemia and constitutes a potentially preventable condition with a great impact on surgical outcome. However, preoperative anemia management is not yet established in most hospitals. Changing workflows and re-thinking is challenging. Numerous published studies confirmed the positive effect of preoperative anemia diagnosis and treatment recen...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Patients with psychiatric disease: implications for anesthesiologists
Purpose of review
Psychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities.
Recent findings
As new treatment modalities become available, their perioperative implications need to be evaluated. These implications include drug–drug interactions, hemodynamic effects, bleeding risk, and factors affecting perioperative exacerbation of the underlying psychiatric illness.
Summary
From our review of the recent literature we continue to support the continuation of psychoactive agents in the periopera...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Perioperative thrombocytopenia
Purpose of review
In this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia.
Recent findings
Large contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic plat...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Endocrine emergencies in anesthesia
Purpose of review
An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients.
Recent findings
Perioperative management of pheochromocytoma and paraganglioma has been facilitated by improved medical management and the adoption of minimally invasive surgical techniques. An improved understanding of the sequelae of carcinoi...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
Anesthetic technique and cancer surgery outcomes
Purpose of review
Surgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes.
Recent findings
To date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to de...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Adriana D. Oprea Source Type: research
