Current Opinion in Anesthesiology最新文献

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-14 DOI: 10.1097/ACO.0000000000001476

David G Mann, Caitlin D Sutton

{"title":"Ethics for the labor and delivery unit.","authors":"David G Mann, Caitlin D Sutton","doi":"10.1097/ACO.0000000000001476","DOIUrl":"10.1097/ACO.0000000000001476","url":null,"abstract":"Purpose of review: The labor and delivery unit poses unique challenges for the clinician faced with an ethical dilemma. Ethics training for physicians is heterogeneous and may not include specifics that are relevant to the obstetric anesthesiologist such as the implications of caring for a maternal-fetal dyad.Recent findings: Rapid changes to the reproductive healthcare landscape have impacted healthcare professionals in recent years, who are at risk for moral distress when faced with ethical dilemmas in clinical care.Summary: Principlism is the most commonly applied ethical theory in clinical medicine. The four principles are autonomy, beneficence, nonmaleficence, and justice. These principles are prima facie in that no one is defined as being consistently more important than another; it is the clinical situation that determines how to prioritize the principles. This framework allows the obstetric anesthesiologist to assess and manage each of these principles to provide ethically appropriate care for their patient. The aim of this article is to provide the obstetric anesthesiologist with an understanding of the foundational ethical principles that impact the ability to fulfill their fiduciary duty to advocate for patients by offering, and with informed consent, providing indicated and appropriate interventions.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411298","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

Towards optimization in the use of hemostatic agents and blood products in the early treatment of patients with traumatic brain injury (TBI).

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-14 DOI: 10.1097/ACO.0000000000001465

Marc Maegele

引用次数: 0

Current opinion: an overview of sickle cell disease and chronic pain and perioperative considerations.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-14 DOI: 10.1097/ACO.0000000000001461

Dolapo Akintunde, Ada Ezihe-Ejiofor, Janefrances Ogbah, Tolulope Oso

{"title":"Current opinion: an overview of sickle cell disease and chronic pain and perioperative considerations.","authors":"Dolapo Akintunde, Ada Ezihe-Ejiofor, Janefrances Ogbah, Tolulope Oso","doi":"10.1097/ACO.0000000000001461","DOIUrl":"10.1097/ACO.0000000000001461","url":null,"abstract":"Purpose: This review aims to provide the practicing anesthesiologist with information on the pathophysiology, physiology, and management of patients with sickle cell disease. This includes the evaluation of common intraoperative management issues as well as perioperative concerns related to the disease. This review will also discuss the outpatient care of sickle cell patients concerning disease-modifying agents and chronic pain management.Recent findings: There has been less funding for research on sickle cell disease and a relative deficit in treatment options for patients and their vaso-occlusive crises (VOC). In the chronic pain setting, adjuvants to therapy have been utilized, such as anti-inflammatories, neuropathic agents, and antihistamines; however, the mainstay of therapy for pain crises is the use of opioids. New medications for the treatment of VOCs include crinaluzimab and L-glutamine. In terms of intraoperative management, it is imperative to maintain homeostasis for the patients, and research does not show a benefit in preoperative blood transfusions when not clinically indicated.Summary: The sociopolitical context and pathophysiology of sickle cell disease make it a unique disease to manage for the practicing anesthesiologist. Tailoring management via developing a patient-specific approach to maintain homeostasis and minimize the perioperative prevalence of VOCs.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411372","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

REBOA for remote damage control resuscitation and the race against time.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-13 DOI: 10.1097/ACO.0000000000001474

Max Marsden, Robert Lendrum, Zane Perkins, Ross A Davenport

{"title":"REBOA for remote damage control resuscitation and the race against time.","authors":"Max Marsden, Robert Lendrum, Zane Perkins, Ross A Davenport","doi":"10.1097/ACO.0000000000001474","DOIUrl":"10.1097/ACO.0000000000001474","url":null,"abstract":"Purpose of review: The management of noncompressible haemorrhage (NCH) remains a critical challenge in trauma care, with early mortality rates persistently high despite advances in trauma systems. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a potential intervention to address severe haemorrhage in prehospital and hospital settings. This review examines the role of REBOA in remote damage control resuscitation, focusing on the 'golden hour' and the 'platinum 5 minutes' concepts that underscore the urgency of timely interventions.Recent findings: Evidence from the UK-REBOA trial and related studies highlights the complexity of implementing REBOA in prehospital settings, emphasising the importance of early deployment, appropriate patient selection, and minimisation of delays. Technological innovations, including AI-assisted decision-making and automated partial REBOA systems, offer promising avenues for optimising REBOA's application. Furthermore, the concept of damage control prehospital care prioritises essential interventions tailored to individual patient needs, advocating for a streamlined approach to reduce on-scene time.Summary: The integration of REBOA with advanced prehospital strategies holds the potential for reducing preventable deaths from traumatic haemorrhage, but further research is needed to refine protocols and enhance outcomes in this high-stakes domain.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400672","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

Advances in neonatal resuscitation for the obstetric anesthesiologist.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-13 DOI: 10.1097/ACO.0000000000001462

Raffaella Fantin, Bernd Wallner, Philipp Lichtenberger, Gabriel Putzer, Vera Neubauer, Elke Griesmaier

{"title":"Advances in neonatal resuscitation for the obstetric anesthesiologist.","authors":"Raffaella Fantin, Bernd Wallner, Philipp Lichtenberger, Gabriel Putzer, Vera Neubauer, Elke Griesmaier","doi":"10.1097/ACO.0000000000001462","DOIUrl":"10.1097/ACO.0000000000001462","url":null,"abstract":"Purpose of review: This review provides an updated overview of neonatal resuscitation practices relevant to obstetric anesthesiologists, with a focus on term and late preterm neonates (>34 weeks' gestation). Key topics include umbilical cord management, temperature regulation, airway strategies, and pharmacological interventions, emphasizing evidence-based approaches.Recent findings: Delayed cord clamping enhances neonatal outcomes, including improved blood volume and oxygenation. Positive pressure ventilation remains the cornerstone of neonatal resuscitation, with early initiation reducing mortality. Supraglottic airways are emerging as effective alternatives to face masks. Advances in epinephrine administration and dosing show promise, though evidence gaps persist. Simulation-based training, telemedicine, and artificial intelligence are advancing skill retention and resuscitation support.Summary: Recent advancements in neonatal resuscitation focus on precision in ventilation, thermoregulation, and airway management. Obstetric anesthesiologists play a critical role in neonatal emergencies, underscoring the need for continuous training and the integration of emerging technologies like artificial intelligence to optimize neonatal outcomes.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400626","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 utility of wearable devices in the perioperative period.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-13 DOI: 10.1097/ACO.0000000000001473

Alexander J Xiang, Jenny Xinye Hu, Karim S Ladha

{"title":"The utility of wearable devices in the perioperative period.","authors":"Alexander J Xiang, Jenny Xinye Hu, Karim S Ladha","doi":"10.1097/ACO.0000000000001473","DOIUrl":"10.1097/ACO.0000000000001473","url":null,"abstract":"Purpose of review: Improved perioperative patient monitoring is a crucial step toward better predicting postoperative outcomes. Wearable devices capable of measuring various health-related metrics represent a novel tool that can assist healthcare providers. However, the literature surrounding wearables is wide-ranging, preventing clinicians from drawing definitive conclusions regarding their utility. This review intends to consolidate the recent literature on perioperative wearables and summarize the most salient information.Recent findings: Wearable devices measuring cardiac output and colonic motility have recently been piloted with mixed results. Novel measurement techniques for established metrics have also been studied, including photoplethysmography devices for heart rate and blood pressure along with resistance thermometers for temperature. Nuanced methods of synthesizing data have been piloted, including machine-learning algorithms for predicting adverse events and trajectory curves for step count progression. Wearable devices are generally well accepted, although adjuvant support systems have improved patient satisfaction.Summary: Perioperative wearables are valuable tools for tracking postoperative health metrics, predicting adverse events, and improving patient satisfaction. Future research on removing barriers such as technological illiteracy, artifact generation, and false-positive alarms would enable better integration of wearables into the hospital setting.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400678","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

Restoring hemostasis with prothrombin complex concentrate: benefits and risks in trauma-induced coagulopathy.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-13 DOI: 10.1097/ACO.0000000000001464

Oliver Grottke, Lars Heubner

{"title":"Restoring hemostasis with prothrombin complex concentrate: benefits and risks in trauma-induced coagulopathy.","authors":"Oliver Grottke, Lars Heubner","doi":"10.1097/ACO.0000000000001464","DOIUrl":"10.1097/ACO.0000000000001464","url":null,"abstract":"Purpose of this review: To provide evidence for the use of prothrombin complex concentrate (PCC) as a potential hemostatic treatment for trauma-induced coagulopathy with and without anticoagulants.Recent findings: PCC is effective in enhancing thrombin generation and achieving hemostasis in traumatized patients under anticoagulants. For vitamin K antagonist (VKA) reversal, it shows superior efficacy over fresh frozen plasma, achieving rapid normalization of the international normalized ratio normalization and reduced transfusion needs. In direct oral anticoagulant (DOAC)-associated bleeding, PCC offers an alternative when specific antidotes are unavailable. However, evidence from randomized trials in the field of trauma and coagulopathy is limited, and the results have shown conflicting outcomes in terms of mortality reduction. Further, following PCC application, thromboembolic risks remain a particular concern. Monitoring tools such as thrombin generation assays and point-of-care tests show promise but are not universally available.Summary: PCC is a valuable option for managing coagulopathy in specific settings, especially VKA and DOAC reversal. Based on current evidence, we caution against the use of PCC as a versatile hemostatic agent suitable for indications involving multiple clotting factor deficiencies for uncontrolled coagulopathic bleeding in trauma or other clinical settings outside anticoagulation reversal. The risk vs. benefit profile should be carefully examined, similar to any other agent.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400674","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

Individualized and targeted coagulation management in bleeding trauma patients.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-13 DOI: 10.1097/ACO.0000000000001467

Nikolaus Hofmann, Herbert Schöchl, Johannes Gratz

{"title":"Individualized and targeted coagulation management in bleeding trauma patients.","authors":"Nikolaus Hofmann, Herbert Schöchl, Johannes Gratz","doi":"10.1097/ACO.0000000000001467","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001467","url":null,"abstract":"Purpose of review: This review aims to summarize current evidence on hemostatic management of bleeding trauma patients, with a focus on resuscitation strategies using either coagulation factor concentrates or fixed-ratio transfusion concepts. It discusses the potential benefits and limitations of both approaches.Recent findings: Recent studies have shown that coagulopathy caused by massive traumatic hemorrhage often cannot be reversed by empiric treatment. During initial resuscitation, a fixed-ratio transfusion approach uses the allogeneic blood products red blood cells, plasma, and platelets to mimic 'reconstituted whole blood'. However, this one-size-fits-all strategy risks both overtransfusion and undertransfusion in trauma patients. Many European trauma centers have shifted toward individualized hemostatic therapy based on point-of-care diagnostics, particularly using viscoelastic tests. These tests provide rapid insight into the patient's hemostatic deficiencies, enabling a more targeted and personalized treatment approach.Summary: Individualized, goal-directed hemostatic management offers several advantages over fixed-ratio transfusion therapy for trauma patients. However, there is a paucity of data regarding the direct comparison of these two approaches.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411301","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

Bleeding management of thoracic trauma.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-12 DOI: 10.1097/ACO.0000000000001469

Marie Werner, Benjamin Bergis, Jacques Duranteau

{"title":"Bleeding management of thoracic trauma.","authors":"Marie Werner, Benjamin Bergis, Jacques Duranteau","doi":"10.1097/ACO.0000000000001469","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001469","url":null,"abstract":"Purpose of review: Thoracic injuries are directly responsible for 20-30% of deaths in severe trauma patients and represent one of the main regions involved in preventable or potentially preventable deaths. Controlling bleeding in thoracic trauma is a major challenge because intrathoracic hemorrhagic lesions can lead to hemodynamic instability and respiratory failure.Recent findings: The aim of managing intrathoracic hemorrhagic lesions is to control bleeding as quickly as possible and to control any respiratory distress. Extended focus assessment with sonography for trauma enables us to identify intrathoracic bleeding much more quickly and to determine the most appropriate therapeutic strategy.Summary: Thoracic bleeding can result from the diaphragm, intrathoracic vessels (aorta, but also inferior or superior vena cava, and suprahepatic veins), lung, cardiac, or chest wall injuries. Depending on thoracic lesions (such as hemothorax or hemopericardium), hemodynamic instability, and respiratory failure, a pericardial window approach, sternotomy, thoracotomy, or emergency resuscitation thoracotomy may be considered after discussion with the surgeon. Alongside treatment of injuries, managing oxygenation, ventilation, hemodynamic, and coagulopathy are essential for the patient's outcome.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400633","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 integration of telehealth in antenatal anesthesia consults.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-12 DOI: 10.1097/ACO.0000000000001460

Katelyn Scharf, Paloma Toledo

{"title":"The integration of telehealth in antenatal anesthesia consults.","authors":"Katelyn Scharf, Paloma Toledo","doi":"10.1097/ACO.0000000000001460","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001460","url":null,"abstract":"Purpose of review: Telehealth is a popular way for health care providers to connect with patients and is utilized by anesthesiologists across the world for preoperative evaluations. The purpose of this review is to outline the latest literature about telehealth use within obstetric anesthesia.Recent findings: Utilization of telehealth significantly increased during the Coronavirus disease 2019 (COVID-19) pandemic and has proven to be a useful and reliable way to conduct antenatal obstetric anesthesia consultations in high-risk patient groups. Recent publications indicate the reliability and utility of telehealth, especially to reach remote patient populations. This can help anesthesiologists reach patients referred to tertiary centers from remote areas, which can improve the quality and safety of patient care. Furthermore, with hospital-provided infrastructure, the majority of obstetric patients are able to connect with providers via telehealth.Summary: Obstetric anesthesiologists play a pivotal role in the perioperative planning for high-risk pregnant women, and telehealth can serve as a tool to make this easier and more efficient with high patient and provider satisfaction.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400676","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