Has the future arrived? Liposomal bupivacaine versus perineural catheters and additives for interscalene brachial plexus block
Purpose of review
Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself.
Recent findings
Perineural infusion of local anesthetics with interscalene catheters provides superior pain relief with reduction of postoperative op...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research
Wrong-site nerve blocks: evidence-review and prevention strategies
Purpose of review
There has been increasing attention to wrong site medical procedures over the last 20 years. This review aims to provide a summary of the current understanding and recommendations for the prevention of wrong-site nerve blocks (WSNB).
Recent findings
Various procedural, patient, practitioner, and organizational factors have been associated with the risk of WSNB. Recent findings have suggested that the use of a checklist is likely to reduce the incidence of WSNB. However, despite the widespread use of preprocedural checklists, WSNB continue to occur at significant frequency. This may be due to the inab...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research
Current understanding of the fascial plane blocks for analgesia of the chest wall: techniques and indications update for 2020
Purpose of review
Thoracic myofascial plane blocks have gained popularity because of their ease of performance and relative safety. This review highlights current research demonstrating the efficacy of these blocks for specific surgical procedures and provides a brief description of how these techniques are performed.
Recent findings
Fascial plane blocks of the thorax and chest wall have been shown to be beneficial in providing perioperative analgesia for a variety of surgical procedures. Studies discussed in this review compare thoracic fascial plane blocks to systemic analgesia alone, contrast these novel methods of...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research
Diaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic
The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise.
Recent findings
In the last 18 months, study findings on various diaphragm-sparing regional anesthesia techniques have demonstrated comparable block analgesic effectivity with a variable extent of phrenic nerve paralysis. The impact of hemi-diaphragmatic function impairment on clinical outcomes is yet to be established.
Summary
Existing diaphragm...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research
Education and training in ultrasound-guided regional anaesthesia and pain medicine
Purpose of review
Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years.
Recent findings
Twenty-two articles were identified, investigating nine out of the 13 top-ranked research topics in education and training in regional anaesthesia. Research topics addressed by these articles included prerotation simulation, deliberate practice combined with formative assessment tools, validation of assessment tool...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Admir Hadzic Source Type: research
Postoperative delirium: why, what, and how to confront it at your institution
Purpose of review
The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions.
Recent findings
There are few areas of consensus, backed by strong expe...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Interventions to improve perioperative neurologic outcomes
Purpose of review
Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common perioperative neurologic complications. We will also discuss strategies to help prevent and mitigate these complications for our patients.
Recent findings
There are several strategies the anesthesiologist can undertake to prevent or treat conditions, such as perioperative neurocognitive disorders, spinal cord ischemia, perioperative stroke, and postoperative visual loss.
Summary
A thorough understanding of threats to patients’ neurologic...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Prospects of molecular hydrogen in perioperative neuroprotection from basic research to clinical application
Purpose of review
The current systematic review summarizes recent, basic clinical achievements regarding the neuroprotective effects of molecular hydrogen in distinct central nervous system conditions.
Recent findings
Perioperative neuroprotection remains a major topic of clinical anesthesia. Various gaseous molecules have previously been explored as a feasible therapeutic option in neurological disorders. Among them, molecular hydrogen, which has emerged as a novel and potential therapy for perioperative neuroprotection, has received much attention.
Summary
Fundamental and clinical evidence supports the antioxidan...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Cognitive declines after perioperative covert stroke: Recent advances and perspectives
Purpose of review
With the aging of the population, there are increasing number of aged patients who require surgical interventions. Perioperative covert stroke is emerging as an important health threat and social burden that could affect patients’ long-term neurological outcomes.
Recent findings
Recent findings of the association between perioperative covert stroke with long-term cognitive declines of surgical patients highlighted the significance of the silent cognitive function killer—perioperative covert stroke. Considering the devastating long-term consequence of the asymptomatic covert stroke, early diagnosi...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Intraoperative hypotension and neurological outcomes
Purpose of review
Intraoperative hypotension (IOH) may render patients at a risk of cerebral hypoperfusion with decreasing cerebral blood flow (CBF), and lead to postoperative neurological injury. On the basis of the literature in recent years, this review attempts to refine the definition of IOH and evaluate its impact on neurological outcomes.
Recent findings
Although both absolute and relative blood pressure (BP) thresholds, with or without a cumulative period, have been used in collective clinical studies, no definitive threshold of IOH has been established for neurological complications, including perioperative s...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Anesthesia and the brain after concussion
Purpose of review
To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations.
Recent findings
Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be ...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Ketamine: a versatile tool for anesthesia and analgesia
Purpose of review
Ketamine has been used for decades for a variety of indications. Beyond the historical benefits and effects of ketamine, newer developments have occurred worthy of an update. This review will discuss common uses and indications for ketamine in the perioperative setting, as well as highlight newer indications in recent years.
Recent findings
Multiple studies have examined the use of ketamine in a variety of environments, as ketamine has become more popular in emergency rooms and ICUs. Ketamine may be particularly beneficial in management of burn patients, who often require multiple procedures over the...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Double standard: why electrocardiogram is standard care while electroencephalogram is not?
Purpose of review
Major adverse cardiovascular and cerebrovascular events (MACCE) significantly affect the surgical outcomes. Electrocardiogram (ECG) has been a standard intraoperative monitor for 30 years. Electroencephalogram (EEG) can provide valuable information about the anesthetized state and guide anesthesia management during surgery. Whether EEG should be a standard intraoperative monitor is discussed in this review.
Recent findings
Deep anesthesia has been associated with postoperative delirium, especially in elderly patients. Intraoperative EEG monitoring has been demonstrated to reduce total anesthesia drug...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?
Purpose of review
Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment?
Recent findings
There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although musc...
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Editorial introduction
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - August 28, 2020 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
