Best Practice & Research-Clinical Anaesthesiology最新文献

{"title":"Updates in lung isolation techniques","authors":"Evangelia Samara ,&nbsp;Gabija Valauskaite ,&nbsp;Mohamed R. El Tahan","doi":"10.1016/j.bpa.2024.04.002","DOIUrl":"10.1016/j.bpa.2024.04.002","url":null,"abstract":"<div><p>Innovations and challenges for lung separation or isolation have evolved during the last few years. In this chapter, we present the up-to-date, robust evidence available during the previous five years supporting the positions of the different devices, techniques, and tricks for their use in adult and pediatric patients undergoing various thoracic surgical interventions. Additionally, we presented an update on lung isolation in patients with airway difficulty and the suggested training level to master these techniques.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 1","pages":"Pages 4-17"},"PeriodicalIF":4.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic bronchoscopy: Evolution of advanced diagnostic technologies for pulmonary lesions","authors":"Ifeyinwa C. Ifeanyi,&nbsp;Jagtar Singh Heir,&nbsp;Olakunle Idowu","doi":"10.1016/j.bpa.2024.05.002","DOIUrl":"10.1016/j.bpa.2024.05.002","url":null,"abstract":"<div><p>Lung cancer is among one of the most commonly diagnosed malignancies and is the leading cause of cancer-related mortality in both men and women globally, with an estimated 1.8 million deaths annually. Moreover, it is also the leading cause of cancer related deaths in the United States (U.S.), with an estimated 127,000 deaths annually. Approximately 50% of patients who undergo chest Computed Tomography (CT) are found to have a pulmonary nodule (PN), albeit 95% of these PNs are subsequently found to be benign. Further complicating the challenge of timely detection of lung cancer, is made more difficult by the fact that most patients are totally asymptomatic in early stage of disease.</p><p>However, given that sponsored studies by National Cancer Institute (NCI) and other organizations showed a 20% reduction in lung cancer specific mortality with low dose CT scanning in patients at risk, it is reasonable to assume that clinicians will confront this clinical scenario more frequently. Consequently, due to these significant findings, the United States Preventive Services Task Force (USPSTF) recommended annual screening of high-risk patients. Therefore, as result of these recommendations, 240,000 new lung cancers were diagnosed in the U.S. in 2020, with an estimated 238,000 new cases in 2023. Given the multitude of challenges, the practice guidelines and recommendations for the management of these PNs are often tailored to available resources and trained personnel familiar with the various techniques and technologies.</p><p>This review will discuss the evolution of various advancements when tissue biopsy is required: from sputum cytology, nonguided bronchoscopy, percutaneous CT guided biopsy, guided advanced bronchoscopic techniques such as endobronchial ultrasound (EBUS), radial Endobronchial Ultrasound (rEBUS) to the latest advancement of robotic-assisted bronchoscopy (RAB). Furthermore, as many of the aforementioned techniques require anesthesia, as integral members of the multidisciplinary team, anesthesiologists are often in the unique position of facilitating diagnosis and subsequent treatment by other subspecialists when providing anesthetic care for these patients with PNs.</p><p>Additionally, the common anesthetic considerations and implications for the preoperative, intraoperative, and postoperative periods will be elucidated further, with special emphasis on the unique considerations for RABs. Combined hybrid procedures with RAB, EBUS and surgery will also be reviewed, as they offer potential reduction in time of diagnosis to definitive treatment. Lastly, the strategies employed to mitigate some of the commonly encountered challenges faced by anesthesiologists when caring for these patients will also be reviewed.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 1","pages":"Pages 38-46"},"PeriodicalIF":4.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current (and possible future) role of opioid analgesia in lung cancer surgery","authors":"Alessia Pedoto,&nbsp;Gregory W. Fischer,&nbsp;Joshua S. Mincer","doi":"10.1016/j.bpa.2024.05.001","DOIUrl":"10.1016/j.bpa.2024.05.001","url":null,"abstract":"<div><p>The objectives of this minireview are two-fold. The first is to discuss the evolution of opioid analgesia in perioperative medicine in the context of thoracic non-cardiac surgery. Current standard-of-care, aiming to optimize analgesia and limit undesirable side effects, is discussed in the context of multimodal analgesia, specifically enhanced recovery after thoracic surgery pathways. The second is to review a developing research program that may ultimately add another element to the personalization of analgesic plans for individual cancer patients based on optimizing oncological outcomes. Termed “precision oncoanalgesia,” this emerging field aims to elucidate how individual patient-specific tumor omics (genomics, transcriptomics, etc.) may mediate the effects of analgesic drugs on oncological recurrence and survival.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 1","pages":"Pages 74-80"},"PeriodicalIF":4.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracic anesthesia, ventilation, and oxygen delivery: ‘A review of the recent advancements’","authors":"Stefaan Bouchez,&nbsp;Jan F.A. Hendrickx,&nbsp;Wanda M. Popescu","doi":"10.1016/j.bpa.2024.05.005","DOIUrl":"10.1016/j.bpa.2024.05.005","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 1","pages":"Pages 1-3"},"PeriodicalIF":4.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141281317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Thoracic anesthesia in patients with airborne disease”","authors":"Manuel Granell Gil ,&nbsp;Ruth Martínez Plumed ,&nbsp;Marta Grynovska","doi":"10.1016/j.bpa.2024.04.001","DOIUrl":"10.1016/j.bpa.2024.04.001","url":null,"abstract":"<div><p>Health care workers are at risk of infection from aerosolization of respiratory secretions, droplet and contact spread. This has gained great importance after the COVID19 pandemic.</p><p>Intra-operative aerosol-generating procedures are arguably unavoidable in the routine provision of thoracic anesthesia. Airway management for such patients during the COVID-19 pandemic including tracheal intubation, lung isolation, one-lung ventilation and flexible bronchoscopy may pose a significant risk to healthcare professionals and patients.</p><p>The thoracic anesthetic community has been confronted with the need to modify existing techniques to maximize safety for patients and healthcare professionals.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 1","pages":"Pages 32-37"},"PeriodicalIF":4.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ultrasound in thoracic anesthesia","authors":"Stefaan Bouchez","doi":"10.1016/j.bpa.2024.04.003","DOIUrl":"10.1016/j.bpa.2024.04.003","url":null,"abstract":"<div><p>The use of ultrasound (US) in the perioperative clinical management should be goal-directed, rapid, and reproducible. Thoracic US enables detailed examinations of vital structures, such as the airway, lung, pleural space, diaphragm, and heart. This chapter focuses on the value of US as a bedside tool to assess anatomy, guide procedures, and monitor vital organ function in patients undergoing thoracic surgery.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"38 1","pages":"Pages 18-31"},"PeriodicalIF":4.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESAs in perioperative anemia management: Who, what, how and why?","authors":"Sigismond Lasocki ,&nbsp;Maëva Campfort ,&nbsp;Maxime Leger ,&nbsp;Emmanuel Rineau","doi":"10.1016/j.bpa.2023.10.002","DOIUrl":"10.1016/j.bpa.2023.10.002","url":null,"abstract":"<div><div>Preoperative anemia is frequent and is associated with poor patient outcomes and higher transfusion rates. Perioperative blood transfusion is also associated with poor outcomes. These observations justify efforts to increase hemoglobin levels in anemic patients before surgeries with a moderate to high bleeding risk.</div><div>Erythropoiesis-stimulating agents (ESAs) were developed in the 80s and are now widely used for the treatment of renal and cancer-related anemia. In the perioperative settings, ESAs were successfully proposed for preoperative blood donation programs in the 90s. Since then, substantial evidence has been available demonstrating that high-dose ESAs associated with iron (ideally intravenously), administered 3–4 weeks before surgery, increase perioperative hemoglobin levels and reduce the need for blood transfusion in some surgeries. Different strategies might be proposed ranging from a systematic treatment for all patients with hemoglobin below 13 g/dL (especially in orthopedic and cardiac surgeries) to a more personalized approach to anemia treatment (targeting anemia related to inflammation or renal insufficiency). ESAs might increase the risk of adverse events, including thromboembolism, and the benefit-risk ratio must be carefully weighted for high-risk patients (particularly for those undergoing cancer surgery). The cost-effectiveness of ESA use remains to be evaluated.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 519-526"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135809603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roads travelled: The journey to Patient Blood Management at 35 years","authors":"James P. Isbister","doi":"10.1016/j.bpa.2023.10.001","DOIUrl":"10.1016/j.bpa.2023.10.001","url":null,"abstract":"<div><div>Patient Blood Management evolved in recent years, focusing on the haematopoietic system as relevant to all disciplines of medicine. The allogeneic blood supply chain travels from donation, to fractionation, preservation, and storage, to therapeutic, established treatments, or prophylactics for a wide range of medical conditions. This supply chain ‘connects’ altruistic blood donors to patients in need, symbolising a ‘gift relationship’, emphasising the empathetic bond between donor and recipient.</div><div>In 1988, the author proposed a paradigm shift in blood transfusion and, in 2005, introduced the term Patient Blood Management (PBM). PBM's origins are traceable to the late 19th century, when blood transfusion wasn't feasible for managing exsanguinating haemorrhage or critical anaemia. Landsteiner's discovery of the ABO blood groups firmly established blood component therapy into medical therapeutics. This article recounts the journey from a pre-blood transfusion era patient-centred approach, through the 20th century's blood product focus, and thenceforth back to the patient with the advent of PBM.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 439-450"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-operative tranexamic acid: A standard of care?","authors":"Nicole Relke ,&nbsp;Grace H. Tang ,&nbsp;Michelle Sholzberg","doi":"10.1016/j.bpa.2023.11.006","DOIUrl":"10.1016/j.bpa.2023.11.006","url":null,"abstract":"<div><div><span>Peri-operative bleeding is a major cause of morbidity and mortality in patients undergoing surgery. </span>Tranexamic acid<span>, an antifibrinolytic agent<span><span>, is effective for prevention and treatment of bleeding in a variety of different surgical populations. This review summarizes the evidence supporting the use of tranexamic acid in major surgical settings including cardiac surgery, obstetrics, orthopedic surgery, and non-cardiac surgery. We discuss potential </span>adverse effects with use of tranexamic acid including the theoretical risk of thrombosis. Lastly, we discuss other potential benefits of tranexamic acid including prevention of infection and maintenance of blood-brain barrier integrity.</span></span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 468-476"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does one unit really matter? Immunological effects of transfusion after universal leucodepletion","authors":"Arun Muthukumar ,&nbsp;Juan Jose Guerra-Londono ,&nbsp;Juan P. Cata","doi":"10.1016/j.bpa.2023.10.004","DOIUrl":"10.1016/j.bpa.2023.10.004","url":null,"abstract":"<div><div><span><span>Patients with cancer who receive allogeneic red blood cell transfusions are at risk of </span>adverse reactions of varying severity. One of these reactions is </span>immunomodulation<span><span>, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor. Leucocytes are believed to be implicated in storage lesions and immunomodulation. However, the efficacy of leucodepletion in reducing immunomodulation is controversial. The theoretical link between these three interconnected events - storage lesions, immunomodulation and cancer progression remain controversial and poorly understood. This article summarizes the available evidence on efficacy of leucodepletion, storage lesions and transfusion related immunomodulation, while rationalizing the possible association between an immunomodulation triggering transfusion ‘dose’ in cancer patients and subsequent </span>cancer recurrence.</span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 495-502"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}