Current Opinion in Anesthesiology最新文献

Lung regeneration and lung bioengineering. 肺再生与肺生物工程。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-27 DOI: 10.1097/ACO.0000000000001449

Edmond Cohen

{"title":"Lung regeneration and lung bioengineering.","authors":"Edmond Cohen","doi":"10.1097/ACO.0000000000001449","DOIUrl":"10.1097/ACO.0000000000001449","url":null,"abstract":"Purpose of review: Chronic obstructive pulmonary disease affects more than 65 million people worldwide. Lung transplantation is the only definitive treatment. However, donor availability is limited in meeting the demand.Recent findings: Lung regeneration is a new therapeutic strategy that uses the patient's stem cells to replace dysfunctional tissue and restore functional lung tissue rather than alleviate symptoms. Organoids are a new promising target for human lung regeneration. The AEP cells are isolated from human lung tissue for growth. The 3D organ-like structures conserve the alveolar progenitor's capacity to proliferate and differentiate into various epithelial cell types.Bioengineered organs, from a patient's cells, allow for customized biocompatible organs-on-demand without the need for immunosuppressive therapy. The concept involves the creation of a form of 3D tissue scaffold, to be populated by cells of the desired tissue to be transplanted into the patient, allowing for function as closely to the native organ as possible.Summary: The lung's ability to regenerate extensively after injury suggests that this capability could be promoted in diseases in which loss of lung tissue occurs. Lung bioengineering offers the potential to drastically extend life expectancy in patients with end-stage lung disease. If lung reengineering were successful, it would revolutionize the world of transplantation.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"43-50"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786769","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}

引用次数: 0

The autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders. 术后神经认知障碍中的自主神经系统和胆碱能抗炎反射。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-20 DOI: 10.1097/ACO.0000000000001446

Florian Lammers-Lietz, Claudia Spies, Martina A Maggioni

{"title":"The autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders.","authors":"Florian Lammers-Lietz, Claudia Spies, Martina A Maggioni","doi":"10.1097/ACO.0000000000001446","DOIUrl":"10.1097/ACO.0000000000001446","url":null,"abstract":"Purpose of review: Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with postoperative neurocognitive disorder (PNCD). The vagal cholinergic anti-inflammatory pathway (CAP) has been hypothesized to play a role in POD/PNCD and may be a target for interventions such as transcutaneous auricular stimulation (taVNS). We aim to review associations of heart rate variability (HRV) as an indicator of vagal function with POD and postoperative immune reaction as well as taVNS as a potential preventive intervention for POD.Recent findings: Autonomous nervous system (ANS) dysfunction was a common finding in studies analysing HRV in POD and postoperative cognitive dysfunction, but results were heterogeneous. There was no evidence from HRV analysis that vagal activity prevents overshooting postoperative immune activation, but HRV may help to identify patients at risk for postoperative infections. Animal studies and preliminary trials suggest that taVNS may be used to prevent POD/PNCD.Summary: Our review provides no evidence that CAP suppression is associated with POD/PNCD. Future studies should consider that high vagal tone may also mediate immunosuppression in surgical patients, yielding an increased risk for postoperative infections. Although taVNS is a promising approach to prevent POD/POCD, future studies should take these concerns into account.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711552","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}

引用次数: 0

The role of extracorporeal membrane oxygenation in thoracic anesthesia. 体外膜氧合在胸腔麻醉中的作用。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-12-16 DOI: 10.1097/ACO.0000000000001450

Edda Tschernko, Johannes Geilen, Thomas Wasserscheid

{"title":"The role of extracorporeal membrane oxygenation in thoracic anesthesia.","authors":"Edda Tschernko, Johannes Geilen, Thomas Wasserscheid","doi":"10.1097/ACO.0000000000001450","DOIUrl":"10.1097/ACO.0000000000001450","url":null,"abstract":"Purpose of review: Circulatory and respiratory support with extracorporeal membrane oxygenation (ECMO) has gained widespread acceptance during high-end thoracic surgery. The purpose of this review is to summarize the recent knowledge and give an outlook for future developments.Recent findings: A personalized approach of ECMO use is state of the art for monitoring during surgery. Personalization is increasingly applied during anesthesia for high-end surgery nowadays. This is reflected in the point of care testing (POCT) for anticoagulation and cardiac function during surgery on ECMO combining specific patient data into tailored algorithms. For optimizing protective ventilation MP (mechanical power) is a promising parameter for the future. These personalized methods incorporating numerous patient data are promising for the improvement of morbidity and mortality in high-end thoracic surgery. However, clinical data supporting improvement are not available to date but can be awaited in the future.Summary: Clinical practice during surgery on ECMO is increasingly personalized. The effect of personalization on morbidity and mortality must be examined in the future. Undoubtedly, an increase in knowledge can be expected from this trend towards personalization.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"71-79"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820042","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}

引用次数: 0

Nonintubated video-assisted thoracic surgery: myth or reality? 非插管视频辅助胸外科手术：神话还是现实？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-29 DOI: 10.1097/ACO.0000000000001448

Federico Piccioni, Giulio Luca Rosboch

{"title":"Nonintubated video-assisted thoracic surgery: myth or reality?","authors":"Federico Piccioni, Giulio Luca Rosboch","doi":"10.1097/ACO.0000000000001448","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001448","url":null,"abstract":"Purpose of review: This review discusses nonintubated video-assisted thoracic surgery (NIVATS) by presenting its physiological, technical aspects and recent clinical data from the literature.Recent findings: In the last two decades, NIVATS has gained traction as an alternative to traditional intubated thoracic surgery, offering potential benefits in terms of reduced complications, faster recovery times, and improved patient satisfaction. Several approaches to this technique have been described in the literature, mainly divided into the awake patient technique (awake-NIVATS) and the asleep patient technique (asleep-NIVATS). The availability of various sedatives, numerous devices to ensure good oxygenation, and the countless loco-regional techniques available today for pain control in the thoracic region offer the possibility to develop many anesthesia protocols in this context. Numerous studies have already shown that NIVATS is feasible and safe with proper patient selection and adequate collaboration of the surgical team. Some studies have also shown that NIVATS may improve patient outcomes, but the evidence is still limited.Summary: Literature has demonstrated the feasibility of NIVATS and suggest that it can improve patient outcomes. High-quality international randomized multicenter studies comparing NIVATS and intubated video-assisted thoracic surgery are necessary for a strong comprehension to clarify whether it can be a technique that can guarantee safety and improve the perioperative course of patients.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"38 1","pages":"51-57"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923315","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}

引用次数: 0

Editorial introductions. 编辑介绍。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2025-01-03 DOI: 10.1097/ACO.0000000000001447

引用次数: 0

Preventing, identifying and managing myocardial injury after non cardiac surgery - a narrative review. 非心脏手术后心肌损伤的预防、识别和处理 - 综述。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-12-09 DOI: 10.1097/ACO.0000000000001454

Maria Wittmann, Tugce Dinc, Andrea Kunsorg, Maura Marcucci, Kurt Ruetzler

{"title":"Preventing, identifying and managing myocardial injury after non cardiac surgery - a narrative review.","authors":"Maria Wittmann, Tugce Dinc, Andrea Kunsorg, Maura Marcucci, Kurt Ruetzler","doi":"10.1097/ACO.0000000000001454","DOIUrl":"10.1097/ACO.0000000000001454","url":null,"abstract":"Purpose of review: There is mounting and convincing evidence that patients with postoperative troponin elevation, with or without any clinical symptoms, are at higher risk for both, short- and long-term morbidity and mortality. Myocardial injury after noncardiac surgery (MINS) is a relatively newly described syndrome, and the pathogenesis is not fully understood yet. MINS is now an established syndrome and multiple guidelines address potential etiologies, triggers, as well as preventive and management strategies.Recent findings: Surveillance in high-risk patients is required, as most MINS would otherwise be missed. There is no reliable and established preventive strategy, but several potentially avoidable triggers like hypotension, pain and anemia have been identified. Managing patients with MINS postoperatively includes minimizing triggers (such as hemodynamic abnormalities and anemia) that can continue the damage. Long-term pharmacologic strategies include beta-blockers, statins, antiplatelet agents, and anticoagulation.Summary: MINS affects up to 20% of surgical patients, remains clinically mostly silent, but is associated with elevated morbidity and mortality. A multidisciplinary approach, that includes involvement of anesthesiologists, for the prevention, diagnosis, and treatment of MINS is recommended.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"17-24"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820040","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}

引用次数: 0

Perioperative risk scores: prediction, pitfalls, and progress. 围手术期风险评分：预测、陷阱和进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-20 DOI: 10.1097/ACO.0000000000001445

Jonathan P Bedford, Oliver C Redfern, Benjamin O'Brien, Peter J Watkinson

{"title":"Perioperative risk scores: prediction, pitfalls, and progress.","authors":"Jonathan P Bedford, Oliver C Redfern, Benjamin O'Brien, Peter J Watkinson","doi":"10.1097/ACO.0000000000001445","DOIUrl":"10.1097/ACO.0000000000001445","url":null,"abstract":"Purpose of review: Perioperative risk scores aim to risk-stratify patients to guide their evaluation and management. Several scores are established in clinical practice, but often do not generalize well to new data and require ongoing updates to improve their reliability. Recent advances in machine learning have the potential to handle multidimensional data and associated interactions, however their clinical utility has yet to be consistently demonstrated. In this review, we introduce key model performance metrics, highlight pitfalls in model development, and examine current perioperative risk scores, their limitations, and future directions in risk modelling.Recent findings: Newer perioperative risk scores developed in larger cohorts appear to outperform older tools. Recent updates have further improved their performance. Machine learning techniques show promise in leveraging multidimensional data, but integrating these complex tools into clinical practice requires further validation, and a focus on implementation principles to ensure these tools are trusted and usable.Summary: All perioperative risk scores have some limitations, highlighting the need for robust model development and validation. Advancements in machine learning present promising opportunities to enhance this field, particularly through the integration of diverse data sources that may improve predictive performance. Future work should focus on improving model interpretability and incorporating continuous learning mechanisms to increase their clinical utility.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"30-36"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632106","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}

引用次数: 0

Pro's and con's of different blocks for postoperative analgesia after video-assisted thoracic surgery. 胸腔镜手术后不同阻滞镇痛的利弊。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-12-06 DOI: 10.1097/ACO.0000000000001451

M Ahmet Karakaya, Davud Yapici, Emre Sertac Bingül, Özlem Turhan, Mert Şentürk

引用次数: 0

Integrated psychosocial support in the ICU. ICU的综合社会心理支持。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2025-01-03 DOI: 10.1097/ACO.0000000000001455

Matthias Rose, Katrin Schürmann, Hannah Ferentzi, Katharina R L Schmitt

{"title":"Integrated psychosocial support in the ICU.","authors":"Matthias Rose, Katrin Schürmann, Hannah Ferentzi, Katharina R L Schmitt","doi":"10.1097/ACO.0000000000001455","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001455","url":null,"abstract":"Purpose of review: During treatment in the ICU, patients, relatives, as well as staff members are exposed to a variety of potentially traumatic experiences. The study explores current concepts to prevent negative effects on mental health resulting from intensive care treatment.Recent findings: Most healthcare systems rely on consultation or liaison services to address mental health issues provided by mental health experts based outside of the ICU. Those services usually react to manifest comorbid mental conditions, but are less effective to prevent mental health issues. Integrated psychosocial support (IPS) models acknowledge the fact that psychosocial demands are inherent to ICU treatment rather than an individual concern. First experiences support the assumption that clinical psychologists embedded within the ICU team effectively address the need of early identification of mental health issues, and are able to intervene timely and appropriately to traumatic events on the unit. They professionalize psychosocial support structures and facilitate low-threshold support for team members.Summary: Psychologists integrated in the ICU team can effectively target psychosocial needs of patients and relatives with varying complexity. They support the ICU team by taking on those tasks, and contribute to the overall resilience of the ICU team and its members.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"38 1","pages":"37-42"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922196","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}

引用次数: 0

The climate crisis - actions to prioritize for anaesthesiologists. 气候危机--麻醉医师应优先采取的行动。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-04 DOI: 10.1097/ACO.0000000000001444

Roberta Lawin-O'Brien, Elliot S Schwartz, Hugh Montgomery, Michael Nurok, Mark Coburn

{"title":"The climate crisis - actions to prioritize for anaesthesiologists.","authors":"Roberta Lawin-O'Brien, Elliot S Schwartz, Hugh Montgomery, Michael Nurok, Mark Coburn","doi":"10.1097/ACO.0000000000001444","DOIUrl":"10.1097/ACO.0000000000001444","url":null,"abstract":"Purpose of review: Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do.Recent findings: Encouraging continuing research regarding sustainable anaesthesia and expanding education at all levels to include climate action is key. Professionally, actions include limiting use of single-use equipment, reducing reliance on volatile gas inhalational anaesthesia, and adopting low fresh gas flow techniques. Personal actions such as climate-conscious travelling, spending, and eating are important, especially when shared to create climate positive movements.Summary: This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"9-16"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632067","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}

引用次数: 0