Long-term cognitive and behavioral outcomes following early exposure to general anesthetics
Purpose of review
Nearly 100 clinical studies have been published evaluating neurodevelopmental outcomes in children following surgery and anesthesia. These studies have reported mixed results, likely attributable at least in part to significant heterogeneity in their study designs, types and numbers of exposures, patient populations evaluated, and most importantly, the outcomes that were assessed. This review aims to summarize the results from clinical studies evaluating behavioral outcomes in children exposed to surgery and anesthesia.
Recent findings
Children with early exposure to surgery and anesthesia were...
Source: Current Opinion in Anaesthesiology - July 26, 2022 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Vesna Jevtovic-Todorovic Source Type: research
The role of voltage-gated calcium channels in the mechanisms of anesthesia and perioperative analgesia
Purpose of review
A family of neuronal voltage-gated calcium channels (VGCCs) have received only recently a significant consideration regarding the mechanisms of anesthesia because VGCC inhibition may be important in anesthetic action by decreasing neuronal excitability and presynaptic excitatory transmission. The T-type VGCCs channels (T-channels), although rarely involved in synaptic neurotransmitter release, play an important role in controlling neuronal excitability and in generating spontaneous oscillatory bursting of groups of neurons in the thalamus thought to be involved in regulating the state of arousal and s...
Source: Current Opinion in Anaesthesiology - July 26, 2022 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Vesna Jevtovic-Todorovic Source Type: research
Novel anesthetics in pediatric practice: is it time?
Purpose of review
Steadily mounting evidence of anesthesia-induced developmental neurotoxicity has been a challenge in pediatric anesthesiology. Considering that presently used anesthetics have, in different animal models, been shown to cause lasting behavioral impairments when administered at the peak of brain development, the nagging question, ‘Is it time for the development of a new anesthetic’ must be pondered.
Recent findings
The emerging ‘soft analogs’ of intravenous anesthetics aim to overcome the shortcomings of currently available clinical drugs. Remimazolam, a novel ester-analog of midazolam, i...
Source: Current Opinion in Anaesthesiology - July 26, 2022 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Vesna Jevtovic-Todorovic Source Type: research
Editorial introduction
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - July 26, 2022 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
How to optimize the perioperative care of patients with orphan diseases: what the anesthesiologist needs to know
Purpose of review
Despite a very low individual prevalence, rare or orphan diseases are estimated to collectively affect as much as 6–8% of the general population. These diseases provide a challenge to anesthetic delivery because of the lack of evidence to guide optimal management.
Recent findings
The expansion of information technology has made facts about individual orphan diseases easier to find. Several reputable websites, hosted variously by anesthetic societies, rare disease organizations, and government agencies, provide information about rare diseases and anesthetic management.
Summary
Improved ...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Risk assessment of perioperative neurocognitive disorders, where are we now?
Purpose of review
Perioperative neurocognitive disorders (PNDs) are among the most frequent complications after surgery and are associated with considerable morbidity and mortality. We analysed the recent literature regarding risk assessment of PND.
Recent findings
Certain genetic variants of the cholinergic receptor muscarinic 2 and 4, as well as a marked degree of frailty but not the kind of anaesthesia (general or spinal) are associated with the risk to develop postoperative delirium (POD). Models predict POD with a discriminative power, for example, area under the receiver operating characteristics curve bet...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Opioid abuse and perioperative care: a new medical disease
Purpose of review
This review article aims to describe the perioperative clinical implications of opioid use or opioid use disorder (OUD) and to provide recommendations related to analgesia, anesthesia, and postoperative care for patients with this ’new medical disease’.
Recent findings
Evidence suggest that 1 in 4 surgical patients will be using opioids preoperatively. Management of these patients, or those with OUD, can be challenging given their opioid tolerance, hyperalgesia, decreased pain tolerance, and increased pain sensitivity. Therefore, an individualized plan that considers how to manage OUD treat...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Perioperative considerations for adult patients with obstructive sleep apnea
Purpose of review
Obstructive sleep apnea (OSA) is a common, but often undiagnosed, sleep breathing disorder affecting approximately a third of adult surgical patients. OSA patients have increased sensitivity to anesthetic agents, sedatives, and opioid analgesics.
Recent findings
Newer technologies (e.g., bedside capnography) have demonstrated that OSA patients have repetitive apneic spells, beginning in the immediate postoperative period and peaking in frequency during the first postoperative night. Compared to patients without OSA, OSA patients have double the risk for postoperative pulmonary as well as other ...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Medical disease and ambulatory surgery, new insights in patient selection based on medical disease
Purpose of review
Improvements in perioperative care contributed to enlarge the eligibility criteria for day case surgery and more and more patients with comorbidities may be concerned. However, underlying medical diseases may influence postoperative outcomes, and therefore, must be considered when selecting patients to undergo ambulatory surgery.
Recent findings
To limit postoperative complications, rigid patient selection criteria are often applied in ambulatory surgery. In practice, however, most of these criteria predict the occurrence of treatable perioperative adverse events but not the need for unanticipa...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Individualized multidisciplinary analgesia to prevent persistent postsurgical pain
Purpose of review
Persistent postsurgical pain as outcome of surgery has reached more attention in the past years. In the first place because of related disability, long-term use of (opioid)analgesics and impact on the quality of life of individual patients. In addition, the individual and societal socio-economic burden of PPSP is high and increasing in the light of increasing numbers of surgery world-wide.
Recent findings
Actual studies identified risk factors for persistent postsurgical pain in relevant patient populations. Astonishingly, most of predicting factors seem unrelated to surgery.
Summary
Fut...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Addressing comorbidities in the perioperative setting and optimizing perioperative medicine education
This article reviews current literature to demonstrate the importance of preoperative enhancement of patients’ cognitive and functional status. This article underscores the importance of formal training in multidisciplinary topics, such as frailty, brain health, and shared decision-making for anesthesiology house staff.
Recent findings
Preoperative cognitive screening of older patients is a valuable metric for risk stratification and detection of patients at risk of postoperative delirium. Frailty is another syndrome that can be identified and optimized preoperatively. Sarcopenia has been shown to correlate with f...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Editorial
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Wolfgang Buhre Source Type: research
Monitoring of analgesia level during general anesthesia in children
Purpose of review
Monitoring of intraoperative nociception has made substantial progress in adult anesthesia during the last 10 years. Several monitors have been validated and their use has been associated with intraoperative or postoperative benefits in the adult population. In pediatric anesthesia, less data are available. However, several recent publications have assessed the performance of nociception monitors in children, and investigated their potential benefits in this context. This review will describe the main validated intraoperative nociception monitors, summarize adult findings and describe the available pe...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Christiane Beck Source Type: research
Apneic oxygenation in pediatric anesthesia
Purpose of review
Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia.
Recent findings
Apneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 e...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Christiane Beck Source Type: research
A pragmatic approach to quality improvement in pediatric anesthesia
Purpose of review
The concept of quality improvement (QI) is well implemented in pediatric anesthesia. Conductance, reporting and publishing of QI projects and -results is well described and promoted. However, the perception of quality might differ between stakeholders and beneficiaries. Based on measures of quality as perceived by healthcare professionals and pediatric patients, a pragmatic approach to choosing the relevant quality measure is suggested.
Recent findings
Design of QI projects is often motivated by an incentive to avoid errors and adverse events, and with an overall aim to reduce morbidity and mor...
Source: Current Opinion in Anaesthesiology - June 1, 2022 Category: Anesthesiology Tags: PEDIATRIC ANESTHESIA: Edited by Christiane Beck Source Type: research
