Peripartum considerations in sickle cell disease
Purpose of review
Pregnancy exacerbates sickle cell disease (SCD) and is associated with increased frequency and severity of complications resulting in high levels of maternal and fetal morbidity and mortality. We review recent recommendations for managing SCD in pregnancy.
Recent findings
An updated pathobiological model of SCD now attributes the clinical picture to a vicious cycle of four major cellular disturbances. Management decisions should be guided by an understanding of this upgraded model. Red cell transfusions are a key therapeutic intervention used in managing several acute and chronic complications....
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research
Peripartum optimization and coordination of collaborative care practice: a critical role for the obstetric anesthesiologist in combating maternal morbidity and mortality
Purpose of review
Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation.
Recent findings
Data from the general surgical population would suggest a mortality benefit associated with preoperative anesthesia evaluation, although no such data exists in the obstetric population.
Robust systems for case ascertainment and referral are needed. Recent publications on obstetric comorbidity indices may provide use...
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Jill Mhyre Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - May 12, 2021 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Does thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections?
Purpose of review
Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way.
Recent findings
Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pn...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARIES Source Type: research
Atrial appendage angiotensin-converting enzyme-2, aging and cardiac surgical patients: a platform for understanding aging-related coronavirus disease-2019 vulnerabilities
Purpose of review
Hospitalizations for COVID-19 dramatically increase with age. This is likely because of increases in fragility across biological repair systems and a weakened immune system, including loss of the cardiorenal protective arm of the renin--angiotensin system (RAS), composed of angiotensin-converting enzyme-2 (ACE2)/angiotensin-(1--7) [Ang-(1--7)] and its actions through the Mas receptor. The purpose of this review is to explore how cardiac ACE2 changes with age, cardiac diseases, comorbid conditions and pharmaceutical regimens in order to shed light on a potential hormonal unbalance facilitating SARs-CoV...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARIES Source Type: research
Acute respiratory failure and burn patient outcomes
Purpose of review
Advances in the care of inhalational injuries have not kept pace with advances that have been seen in the treatment of cutaneous burns. There is not yet a standard of care for best outcomes for airway management of patients with known or suspected inhalational injuries. Clinicians must decide if to intubate the patient, and if so, whether to intubate early or late in their presentation. Unnecessary intubation affects morbidity and mortality. This review will summarize literature that highlights present practices in the treatment of patients with inhalation injuries.
Recent findings
There have b...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Toward physician well-being and the mitigation of burnout
This article discusses the drivers of burnout and offers some strategies to mitigate burnout and improve well-being.
Recent findings
Measures of burnout such as stress, micro, and macro-aggression in the workplace have a psychological impact on staff. Additionally, a measurable economic price is exacted when an organization fails to address the lack of well-being burnout represents.
Summary
As healthcare providers struggle to survive and deal with the complex new set of problems and obstacles that the COVID-19 pandemic, the National economic crisis, and the increasing regulatory obligations have summoned fort...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Disclosure after medical error
Purpose of review
Disclosure after medical error is a complex process that goes beyond a single provider and the patient. The types and severity of errors occurring in the practice of anesthesiology may have more implications for patients, requiring a thoughtful approach to the patient, their families and the healthcare system as a whole.
Recent findings
Tenants of the disclosure have been established. Simulation for trainees and practitioners allows for education and preparation for such events.
Summary
Despite education and systems-based improvements in quality and safety in medicine, errors will undoub...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Donation after circulatory death: opportunities on the horizon
Purpose of review
Organ transplantation remains the gold standard therapy for many end-organ diseases. The demand for donor organs continues to grow to far exceed supply. This review summarizes recent protocols, procedures, and ethics surrounding the increased utilization of donors after circulatory death for transplantation.
Recent findings
An increasing number of centers are utilizing donation after circulatory death, and outcomes are improving. Although outcomes from donors after brain death continue to be the primary source of donation, circulatory death outcomes continue to improve approaching the level of ...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Enhanced Recovery After Surgery, Lean, and claims-based quality databases: how does it all make sense?
Purpose of review
Healthcare is rapidly evolving toward value-focused objectives, integrating outcomes and cost instead of simply volume. Concepts pertaining to Enhanced Recovery After Surgery (ERAS), Lean, and claims-based risk-adjusted databases can be used to optimize value, but the application of Lean principles and risk-adjusted outcomes is poorly described in perioperative medicine in perioperative medicine.
Recent findings
Lean management and process optimization tools allow the consistent application of a perioperative medical framework of ERAS to improve outcomes. Vizient risk-stratified outcomes are of...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Procedural episode-based cost measures: anesthesia matters
Purpose of review
Episode-based cost measures (EBCM) is a method of combining all services related to a defined episode of care, identified as either a procedure, acute illness or chronic disease, and providing expected cost for that episode or bundle of care. Procedural EBCM has become a major scheme for payment methodology and patient quality of care evaluation. Anesthesiologists need to know how EBCM can impact their clinical practice.
Recent finding
Centers for Medicare and Medicaid Services (CMS) pays physicians with fee-for-service payment for Clinical Episodes and, in 2020, the EBCM are increasing and cur...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Adequacy of workforce – are there enough critical care doctors in the US-post COVID?
This article explores the ability of American healthcare to adapt to this challenge.
Recent findings
With the COVID-19 pandemic, intensivists, and ventilators have been identified as the most critical components leading to shortages in ICU capacity. Anesthesiologists play a unique role in being able to provide ‘flex capacity’ with critical care staffing, space, and equipment (post-anesthesia care units, operating rooms, and ventilators). With the advent of APPs, intensive care physician staffing ratios may potentially be increased to cover patients safely in a physician-led team model. Tele-medicine expands this...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Gender pay disparity in anesthesiology
Purpose of review
The purpose of this review is to look at the historical and current gender pay gap in healthcare, specifically in the field of anesthesiology, as well as discuss some of the reasons for the difference in compensation and its consequences. Future aims and directions to bridge the gap will also be explored.
Recent findings
Even though women have achieved equality in terms of admission to medical school and residency programs, disparities still exist in terms of compensation for equal or comparable work. However, institutional initiatives to close the pay gap have achieved success.
Summary
...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
The Do Not Resuscitate (DNR) order in the perioperative setting: practical considerations
Purpose of review
Addressing patients’ Do Not Resuscitate (DNR) status in the perioperative setting is important for shared patient decision-making. Although the inherently resuscitative nature of anesthesia and surgery may pose an ethical quandary for clinicians tasked with caring for the patient, anesthesiologist-led efforts need to evaluate all aspects of the DNR order and operative procedures.
Recent findings
Approximately 15% of patients undergoing surgical procedures have a preexisting DNR order (Margolis et al., 1995) [1]. American Society of Anesthesiologists (ASA) and the American College of Surgeons ...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Ethical dilemmas in anesthesia mission trips
Purpose of review
Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips.
Recent findings
Physician volunteers for medical missions may cause significant harm to pat...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
