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Current Opinion in Anaesthesiology

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https://www.readbyqxmd.com/read/30239351/genetics-of-perioperative-pain-management
#1
Senthil Packiasabapathy, Nicole Horn, Senthilkumar Sadhasivam
PURPOSE OF REVIEW: The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives. RECENT FINDINGS: Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl transferase, CYP2D6 and μ-opioid receptor (OPRM1), ATP-binding cassette subfamily B member 1, ABCC3, organic cation transporter 1 genes...
September 18, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30199402/best-perioperative-practice-in-management-of-ambulatory-patients-with-obstructive-sleep-apnea
#2
Mahesh Nagappa, Yamini Subramani, Frances Chung
PURPOSE OF REVIEW: The perioperative outcome in obstructive sleep apnea (OSA) patients undergoing ambulatory surgery can be potentially impacted by the type of anesthetic technique, fluid management and choice of anesthetic agents. This review highlights the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures. RECENT FINDINGS: A recent meta-analysis found that STOP-Bang might be used as a perioperative risk stratification tool...
September 7, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30169341/what-we-can-learn-from-big-data-about-factors-influencing-perioperative-outcome
#3
Victor G B Liem, Sanne E Hoeks, Felix van Lier, Jurgen C de Graaff
PURPOSE OF REVIEW: This narrative review will discuss what value Big Data has to offer anesthesiology and aims to highlight recently published articles of large databases exploring factors influencing perioperative outcome. Additionally, the future perspectives of Big Data and its major pitfalls will be discussed. RECENT FINDINGS: The potential of Big Data has given an incentive to create nationwide and anesthesia-initiated registries like the MPOG and NACOR. These large databases have contributed in elucidating some of the rare perioperative complications, such as declined cognition after exposure to general anesthesia and epidural hematomas in parturients...
August 29, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30169340/early-warning-scores-in-the-perioperative-period-applications-and-clinical-operating-characteristics
#4
Harm-Jan de Grooth, Armand R Girbes, Stephan A Loer
PURPOSE OF REVIEW: Early warnings scores are designed to detect clinical deterioration and promote intervention at the earliest possible moment. Although the ultimate effects on patient outcomes are unclear, early warning scores are now legally mandated in several countries. Here, we review the performance of early warning scores in surgical and perioperative populations. RECENT FINDINGS: Early warning scores can be used to screen for postoperative deterioration and surgical complications...
August 29, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30169339/perioperative-cognitive-evaluation
#5
Anastasia Borozdina, Ega Qeva, Marco Cinicola, Federico Bilotta
PURPOSE OF REVIEW: This article reviews the recent clinical evidence published between January 2017 and June 2018 - related to perioperative cognitive evaluation. Namely, new insights into risk factors, prevention, diagnosis and diagnostic tools and treatment. RECENT FINDINGS: Several risk factors (preoperative, intraoperative and postoperative) have been found to be associated with the development of postoperative delirium (POD) and/or postoperative cognitive dysfunction (POCD)...
August 29, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30148715/office-based-surgery-and-patient-outcomes
#6
Steven Young, Fred E Shapiro, Richard D Urman
PURPOSE OF REVIEW: The purpose of this review is to provide an update on the current knowledge about patient safety and outcomes in the office-based setting. Ambulatory procedures performed outside the hospital are steadily increasing, resulting in an increasing number and complexity of office-based procedures and patient comorbidities over the past two decades. In this review we focus on most recent outcomes studies encompassing different surgical specialties and patient populations...
August 24, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30124544/rebound-pain-after-regional-anesthesia-in-the-ambulatory-patient
#7
Patricia Lavand'homme
PURPOSE OF REVIEW: Regional anesthesia is popular in ambulatory setting allowing safe and fast recovery. The problem of 'rebound pain', that is very severe pain when peripheral nerve block (PNB) wears off represents a clinically relevant problem and a cause of increased healthcare resource utilization. This review tries to make the point on a not so rare, unwanted and often neglected side effect of PNB. RECENT FINDINGS: The major finding is the lack of large prospective studies...
August 18, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30124543/drug-selection-for-ambulatory-procedural-sedation
#8
Clemens R M Barends, Anthony R Absalom, Michel M R F Struys
PURPOSE OF REVIEW: Ambulatory procedural sedation is used to relieve anxiety, pain and discomfort in a broad spectrum of patients during many types of diagnostic or therapeutic procedures. This review focuses on recent comparative studies of commonly used and new drugs for adult ambulatory sedation. RECENT FINDINGS: Midazolam and propofol are commonly used for ambulatory sedation. Their pharmacological properties offer many advantages and there is much experience with their use...
August 18, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30124542/echo-guided-invasive-pain-therapy-indications-and-limitations
#9
Yasmine Hoydonckx, Philip Peng
PURPOSE OF REVIEW: The purposes of this review are to summarize the advantages and limitations of ultrasound-guided pain interventions, and to illustrate those interventions with peripheral, axial and musculoskeletal pain procedures. RECENT FINDINGS: With the capability of locating the interfascial plane, ultrasonography has led to the emergence of a series of plane blocks for the thoracoabdominal region in the recent decade.Ultrasonography for musculoskeletal procedures has been of growing interest because of the major advantage of direct visualization and scanning of various soft tissues and real-time spread in the injectate, thereby enhancing precision and efficacy, reducing risk of trauma and avoidance of radiation...
August 18, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30124541/neuromonitoring-in-the-ambulatory-anesthesia-setting-a-pro-con-discussion
#10
Jeffrey O Grosland, Michael M Todd, Peter A Goldstein
PURPOSE OF REVIEW: Various neurologically focused monitoring modalities such as processed electroencephalography (pEEG), tissue/brain oxygenation monitors (SbO2), and even somatosensory evoked responses have been suggested as having the potential to improve the well tolerated and effective delivery of care in the setting of outpatient surgery. The present article will discuss the pros and cons of such monitors in this environment. RECENT FINDINGS: There is a paucity of evidence from rigorous, well designed clinical trials demonstrating that the routine use of any neuromonitoring technique in an ambulatory surgery setting leads to meaningful cost savings or a reduction in morbidity or mortality...
August 18, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30095483/postanesthesia-care-by-remote-monitoring-of-vital-signs-in-surgical-wards
#11
Christa Boer, Hugo R Touw, Stephan A Loer
PURPOSE OF REVIEW: This narrative review summarizes recent insights into the role of remote monitoring of vital signs in the postoperative period in surgical wards. RECENT FINDINGS: Despite recent improvements in the safety of anesthesia and surgical procedures, postoperative complication rates are still unacceptably high. This is partly attributable to the intermittent provision of personal care to patients by nurses and ward physicians. Continuous remote monitoring of vital functions in the early postoperative period may reduce these complication rates...
August 7, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30074492/extended-release-bupivacaine-formulations-for-postoperative-analgesia-an-update
#12
Angela Lucia Balocco, Pieter G E Van Zundert, Sophie S Gan, Tong J Gan, Admir Hadzic
PURPOSE OF REVIEW: New formulations of local anesthetics with sustained release and longer duration of action are being developed to improve patient outcomes following surgery. This review summarizes the efficacy and safety of the three most recently developed extended-release formulations of the local anesthetic, bupivacaine. RECENT FINDINGS: Bupivacaine liposome injectable suspension (EXPAREL) encapsulates bupivacaine in biodegradable liposomes. It is currently the only extended-release formulation of bupivacaine approved by the FDA for infiltration of the tissues during surgery and for interscalene nerve block analgesia following shoulder surgery...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30063486/informed-consent-for-regional-anesthesia
#13
Sarah Tierney, Anahi Perlas
PURPOSE OF REVIEW: This narrative review describes the current framework for informed consent discussions for regional anesthesia practice from an ethical and medicolegal stand point as the cornerstone of the patient-physician relationship and the respect for patient autonomy. Recent guidelines and position statements from anesthesia societies have emphasized the importance of these discussions and their appropriate documentation. RECENT FINDINGS: Recent studies have shown that patients want to know more about both common and benign, as well as rare but serious adverse events, as it relates to their anesthetic care...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30028733/mechanisms-of-acute-and-chronic-pain-after-surgery-update-from-findings-in-experimental-animal-models
#14
Esther Pogatzki-Zahn, Daniel Segelcke, Peter Zahn
PURPOSE OF REVIEW: Management of postoperative pain is still a major issue and relevant mechanisms need to be investigated. In preclinical research, substantial progress has been made, for example, by establishing specific rodent models of postoperative pain. By reviewing most recent preclinical studies in animals related to postoperative, incisional pain, we outline the currently available surgical-related pain models, discuss assessment methods for pain-relevant behavior and their shortcomings to reflect the clinical situation, delineate some novel clinical-relevant mechanisms for postoperative pain, and point toward future needs...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30020157/intraoperative-neurophysiological-monitoring-in-neuroanesthesia
#15
Rogean R Nunes, Carlos D A Bersot, João G Garritano
PURPOSE OF REVIEW: The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM). RECENT FINDINGS: Over the last decades, neuromonitoring has advanced considerably, allowing for insights into neurological function during anesthesia and making it possible to assess intraoperative consciousness and neural integrity in real time...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30020156/anesthesia-for-stroke-rescue
#16
Ayòtúndé B Fadayomi, Oluwaseun Akeju
PURPOSE OF REVIEW: To highlight the potential implications of recent advances in the management of large vessel occlusions for intraprocedural anesthetic management. RECENT FINDINGS: Stroke remains the leading cause of disability in the United States and the second leading cause of death in the world. Several randomized control trials published within the past decade have helped to make endovascular thrombectomy the standard of care for all eligible patients. However, whether intraprocedural anesthesia care practices may significantly improve in-hospital and out-of-hospital morbidity and mortality outcomes are not clear...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30020155/an-update-on-regional-analgesia-for-rib-fractures
#17
Venkatesan Thiruvenkatarajan, Hillen Cruz Eng, Sanjib Das Adhikary
PURPOSE OF REVIEW: To provide an update on new strategies for pain management after rib fractures utilizing regional analgesia. RECENT FINDINGS: Pain management for patients with rib fractures can be very challenging. Traditionally, intravenous patient-controlled analgesia (IVPCA) with opioids, epidural, and paravertebral blocks have been used. These techniques, however, may be contraindicated or have limited application in certain patient populations. Recently, ultrasound-guided myofascial plane blocks such as the erector spinae plane (ESP) block and the serratus anterior plane (SAP) block have emerged as alternatives; providing excellent analgesia with minimal side effects...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30020154/periprocedural-management-of-patients-with-subarachnoid-hemorrhage
#18
Paolo Gritti, Ferdinando L Lorini, Luigi A Lanterna, Federico Bilotta
PURPOSE OF REVIEW: Anesthesiologists and intensivists may be involved in the management of aneurysmal subarachnoid hemorrhage (aSAH) patients at various stages of care. This article will review the recent advances in the periprocedural management of aSAH patients. RECENT FINDINGS: New scoring systems to assess gravity and prognosis of aSAH patients have been evaluated and proposed. Rebleeding still remains, with early aneurysmal treatment, a major challenge in the first hours of aSAH management...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30020153/outcomes-of-regional-anesthesia-in-cancer-patients
#19
Juan P Cata
PURPOSE OF REVIEW: To summarize the current evidence on the impact of regional anesthesia or analgesia on cancer recurrence. RECENT FINDINGS: Preclinical investigations suggest that regional anesthesia could have a positive impact on reducing cancer growth and progression. Regional anesthesia is also associated with better immunological and stress-related outcomes in patients undergoing major oncological surgery. Most recent retrospective studies do not show any benefit of regional anesthesia or analgesia on cancer recurrence or recurrence-free survival...
October 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/30015638/fluid-management-concepts-for-severe-neurological-illness-an-overview
#20
Boris D Heifets, Pedro Tanaka, Mark A Burbridge
PURPOSE OF REVIEW: The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. RECENT FINDINGS: In this review, several gaps in our collective knowledge are summarized, including a rigorous definition of volume status that can be practically measured; an understanding of how electrolyte derangements interact with therapy; a measurable endpoint against which we can titrate our patients' fluid balance; and agreement on the composition of fluid we should give in various clinical contexts...
October 2018: Current Opinion in Anaesthesiology
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