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Current Opinion in Anaesthesiology

Chris Durkin, Travis Schisler, Jens Lohser
PURPOSE OF REVIEW: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection...
October 18, 2016: Current Opinion in Anaesthesiology
Volker Wenzel, Nikolaus Gravenstein
PURPOSE OF REVIEW: Mentoring is fundamentally valuable and important to students considering a path into our specialty, as well as to colleagues already in it and with ambition to advance. General principles and personal experiences are collected and described to help inform future mentors and to reinforce the value of having a mentor and the satisfaction (and work) that is associated with such a role. RECENT FINDINGS: Detecting a latent talent among medical students or residents may be challenging but is worth the effort to develop personal careers and the specialty itself...
October 18, 2016: Current Opinion in Anaesthesiology
Andrea Bowyer, Colin F Royse
PURPOSE OF REVIEW: Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment...
October 18, 2016: Current Opinion in Anaesthesiology
Thomas Fuchs-Buder, Réka Nemes, Denis Schmartz
PURPOSE OF REVIEW: To revise the current literature on concepts for neuromuscular block management. Moreover, consequences of incomplete neuromuscular recovery on patients' postoperative pulmonary outcome are evaluated as well. RECENT FINDINGS: The incidence of residual paralysis may be as high as 70% and even small degrees of residual paralysis may have clinical consequences. Neostigmine should not be given before return of the fourth response of the train-of-four-stimulation and no more than 40-50 μg/kg should be given...
October 14, 2016: Current Opinion in Anaesthesiology
Tennille N Webb, Stuart L Goldstein
PURPOSE OF REVIEW: The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) continues to increase and is associated with significant morbidity and mortality. Early diagnosis and identification of patients at risk are extremely important. Therefore, identifying associated risk factors, biomarkers for earlier detection, prevention and therapeutic options for CS-AKI warrant special attention. RECENT FINDINGS: The current diagnosis of acute kidney injury (AKI) largely depends upon the functional biomarkers serum creatinine and oliguria leading to delays in diagnosis and worsening outcomes...
September 29, 2016: Current Opinion in Anaesthesiology
Sofia Geralemou, Tong J Gan
PURPOSE OF REVIEW: Postoperative and postdischarge nausea and vomiting have profound impact on the efficient delivery of quality healthcare. In addition to patient dissatisfaction, physical morbidities as well as unplanned hospital admissions may result. It is important to risk stratify and intervene on patients at risk. The aim of this review is to explore the benefits and shortcomings of the scoring systems commonly used today. RECENT FINDINGS: Two widely-used risk stratification systems identify and score patient-, anesthesia-, and surgery-related risk factors for postoperative/postdischarge nausea and vomiting in the adult population...
September 29, 2016: Current Opinion in Anaesthesiology
Toby N Weingarten, Lindsay L Warner, Juraj Sprung
PURPOSE OF REVIEW: Opioid-induced postoperative respiratory depression has garnered attention and calls for vigilance. However, a higher level of monitoring equates to increased use of hospital resources and is impractical to apply for all postoperative patients. Understanding the temporal pattern of postoperative respiratory emergency occurrences would allow for improved triage of monitoring resources for high-risk patients. Our objective is to describe the temporal pattern of risk of postoperative opioid-induced respiratory failure...
September 28, 2016: Current Opinion in Anaesthesiology
Mark J Rice
No abstract text is available yet for this article.
September 28, 2016: Current Opinion in Anaesthesiology
Jeremy D Deer, Amod Sawardekar, Santhanam Suresh
PURPOSE OF REVIEW: The objective of this review is to provide an overview of recent developments in pediatric regional anesthesia and elucidate outcomes as it relates to patient safety and overall satisfaction. RECENT FINDINGS: Since the inception of the Pediatric Regional Anesthesia Network database, the acquisition of data has enabled the pediatric anesthesiologist to extrapolate results and translate them into useful outcomes. Despite the growing trend to provide regional anesthesia in the pediatric population, there continues to be a paucity of available research studies to evaluate outcomes of various regional nerve blocks...
September 28, 2016: Current Opinion in Anaesthesiology
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequently occurring complication. It carries the risks of increasing mortality and development of chronic kidney disease. The complex pathophysiologic mechanisms still remain unexplained to a large extent. As a result, there is a considerable lack of sufficient therapeutic strategies with renal replacement therapy still representing the cornerstone for the treatment of severe AKI. RECENT FINDINGS: The identification of patients at high risk for the development of CSA-AKI and the implementation of new biomarkers are the initial steps to be taken toward the prevention of AKI...
September 20, 2016: Current Opinion in Anaesthesiology
Adam B King, Bret D Alvis, Matthew D McEvoy
PURPOSE OF REVIEW: The purpose of this review is to summarize the current state of perioperative medicine, including the perioperative surgical home (PSH) and enhanced recovery after surgery pathways (ERAS) as well as the educational implications of these concepts for current and future anesthesiology trainees. RECENT FINDINGS: Although there is significant, ongoing discussion surrounding the structural concept of the PSH, there remains little clinical evidence to support its development...
September 20, 2016: Current Opinion in Anaesthesiology
Steven Gayer, Howard D Palte
PURPOSE OF REVIEW: Needle-based and cannula-based eye blocks are 'blind' techniques prone to rare but serious complications. Ultrasound, an established adjunct for peripheral nerve block, may be beneficial for ophthalmic anesthesia application. The present review details the evolution of ultrasound-guided eye blocks, outlines safety issues, and reviews recent studies and editorial opinions. RECENT FINDINGS: Ultrasound-assisted ophthalmic regional anesthesia allows imaging of key structures such as the globe, orbit, and optic nerve...
September 20, 2016: Current Opinion in Anaesthesiology
Richard E Galgon
PURPOSE OF REVIEW: The purpose of this article is to provide a structural and functional understanding of the systems used for the regulation of medical devices in the USA and European Union (EU). RECENT FINDINGS: Safe and effective anesthesia care depends heavily on medical devices, including simple, low risk devices to complex life-supporting and life-sustaining devices. In the USA and EU, the Food and Drug Administration and European Commission, respectively, provide regulatory oversight to ensure medical devices are reasonably safe and effective when used for their intended purposes...
August 31, 2016: Current Opinion in Anaesthesiology
Erica J Stein, David B Glick
PURPOSE OF REVIEW: Initial studies suggested that the use of processed electroencephalogram technology could significantly decrease the incidence of unintended intraoperative awareness events during general anesthesia. Subsequent work has cast doubts on these findings. This review will examine the current state of awareness monitoring. RECENT FINDINGS: Recently published randomized controlled trials examining the use of the bispectral index during general anesthesia have not been able to show superiority over other forms of monitoring depth of anesthesia, such as end-tidal anesthetic-agent concentration...
August 31, 2016: Current Opinion in Anaesthesiology
Matthieu Komorowski, Sarah Fleming, Jochen Hinkelbein
PURPOSE OF REVIEW: Missions to the Moon or more distant planets are planned in the next future, and will push back the limits of our experience in providing medical support in remote environments. Medical preparedness is ongoing, and involves planning for emergency surgical interventions and anaesthetic procedures. This review will summarize what principles of ambulatory anaesthesia on Earth could benefit the environment of a space mission with its unique constraints. RECENT FINDINGS: Ambulatory anaesthesia relies on several principles such as improved patient pathway, correct patient selection, optimized procedural strategies to hasten recovery and active prevention of postoperative complications...
August 31, 2016: Current Opinion in Anaesthesiology
Teus H Kappen, Linda M Peelen
PURPOSE OF REVIEW: Perioperative prediction models can help to improve personalized patient care by providing individual risk predictions to both patients and providers. However, the scientific literature on prediction model development and validation can be quite technical and challenging to understand. This article aims to provide the necessary insight for clinicians to assess the value of a prediction model that they intend to use in their clinical practice. RECENT FINDINGS: Recent developments in prediction model research include the continuous development of new performance characteristics for prediction models, increasing insight into the limitations of old characteristics, as well as an improved understanding of the generalizability of prediction models to new populations and practices...
August 16, 2016: Current Opinion in Anaesthesiology
(no author information available yet)
No abstract text is available yet for this article.
October 2016: Current Opinion in Anaesthesiology
Lia D Ernst, Eilis A Boudreau
PURPOSE OF REVIEW: Recent advances in our understanding of seizure generation have resulted in modified recommendations for when seizure treatment should be initiated, revisions to our definition of status epilepticus, and new pharmacological and neuromodulatory therapies. The goal of this review is to provide the anesthesiologist with an overview of the advancements they are most likely to encounter while providing clinical care. RECENT FINDINGS: There have been recent modifications to seizure definitions and treatment recommendations...
October 2016: Current Opinion in Anaesthesiology
Joseph Solberg, David Copenhaver, Scott M Fishman
PURPOSE OF REVIEW: This review offers a critical examination of the biomechanical model that posits the posterior elements as a substantial contributor to pain in vertebral fracture. Further, the review assesses the treatment of posterior-element-associated pain in the setting of vertebral compression fracture in relation to vertebral augmentation. RECENT FINDINGS: In 2015, the only prospective randomized trial comparing percutaneous vertebroplasty with facet blockade was published in which authors found that percutaneous vertebroplasty produced better pain relief and function based on Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analog scale in the short term (≤1 week)...
October 2016: Current Opinion in Anaesthesiology
Marc R Suter
PURPOSE OF REVIEW: The review aims to present the latest research into microglia and their role in pain. RECENT FINDINGS: Microglia affect sex and age-dependent differences in pain. The various microglial phenotypes make their involvement in pain more complex but provide more potential as pain modulators. SUMMARY: Glial cells, composed of microglia, astrocytes, and oligodendrocytes, outnumber neurons in the central nervous system. The crosstalk between these cells and neurons is now established as participating in the development of chronic pain...
October 2016: Current Opinion in Anaesthesiology
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