Current Opinion in Anesthesiology最新文献_第10页

Opioid alternatives in spine surgeries. 脊柱手术中的阿片类药物替代品。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-08-06 DOI: 10.1097/ACO.0000000000001423

Shobana Rajan, Gaiha Rishi, Marco Ibrahim

{"title":"Opioid alternatives in spine surgeries.","authors":"Shobana Rajan, Gaiha Rishi, Marco Ibrahim","doi":"10.1097/ACO.0000000000001423","DOIUrl":"10.1097/ACO.0000000000001423","url":null,"abstract":"Purpose of review: The escalating opioid crisis has intensified the need to explore alternative pain management strategies for patients undergoing spine surgery. This review is timely and relevant as it synthesizes recent research on opioid alternatives for perioperative management, assessing their efficacy, side effects, and postoperative outcomes.Recent findings: A systematic search was conducted to capture articles from the past 18 months that examined opioid-sparing strategies. Findings indicate that multimodal analgesia, incorporating nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, lidocaine, gabapentinoids, N-methyl-D-aspartate (NMDA) antagonists, dexmedetomidine, and emerging regional block techniques like the erector spinae block and TLIF (thoraco lumbar interfascial block), can significantly reduce opioid consumption without compromising pain relief. Additionally, these approaches reduce opioid-related side effects such as postoperative nausea, vomiting, and prolonged hospital stays.Summary: The use of multimodal analgesia aligns with current pain management guidelines and addresses public health concerns related to opioid misuse. While effective, these alternatives are not without side effects, and the ultimate outcome depends on balancing benefits and risks. Future research should focus on the long-term outcomes of opioid alternatives, their effectiveness across diverse populations, and further validation and optimization of these strategies.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"470-477"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983809","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

Anesthesia for traumatic brain injury. 脑外伤麻醉。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-04 DOI: 10.1097/ACO.0000000000001404

Nys Willem Siebers, Luzius A Steiner

{"title":"Anesthesia for traumatic brain injury.","authors":"Nys Willem Siebers, Luzius A Steiner","doi":"10.1097/ACO.0000000000001404","DOIUrl":"10.1097/ACO.0000000000001404","url":null,"abstract":"Purpose of review: Traumatic brain injury (TBI) presents complex clinical challenges, requiring a nuanced understanding of its pathophysiology and current management principles to improve patient outcomes. Anesthetists play a critical role in care and need to stay updated with recent evidence and trends to ensure high-quality treatment. The Brain Trauma Foundation Guidelines, last updated in 2016, have shown moderate adherence, and much of the current management relies on expert opinions. This literature review synthesizes the current evidence and provides insights into the role of anesthetists in TBI management.Recent findings: Recent literature has emphasized the importance of tailored anesthetic management principles in treating TBI, focusing on minimizing secondary brain injury during neurosurgical interventions or extracranial surgery. Emerging trends include individualized intracranial pressure approaches and multimodal neuromonitoring for comprehensive assessment of cerebral physiology.Summary: Anesthesia for TBI patients requires a comprehensive approach that balances anesthetic goals with the unique pathophysiological factors of brain injury. Despite recent research expanding our understanding, challenges remain in standardizing protocols and addressing individual patient response variability. Adherence to established management principles, personalized approaches, and ongoing research is crucial for improving the outcomes.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"486-492"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621660","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

Keeping patients in the dark: perioperative anesthetic considerations for patients receiving 5-aminolevulinic acid for glioma resection. 让患者蒙在鼓里：接受 5-氨基乙酰丙酸治疗胶质瘤切除术的患者围手术期麻醉注意事项。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-12 DOI: 10.1097/ACO.0000000000001406

Benish Fatima, Lauren K Licatino, Arnoley S Abcejo

{"title":"Keeping patients in the dark: perioperative anesthetic considerations for patients receiving 5-aminolevulinic acid for glioma resection.","authors":"Benish Fatima, Lauren K Licatino, Arnoley S Abcejo","doi":"10.1097/ACO.0000000000001406","DOIUrl":"10.1097/ACO.0000000000001406","url":null,"abstract":"Purpose of review: 5-Aminolevulinic acid hydrochloride (5-ALA), available under the trade name Gleolan, is an orally administered fluorophore drug used to enhance visual differentiation of cancerous tissue from healthy tissue, primarily during surgical resection of high-grade gliomas. Although given preoperatively, 5-ALA has important implications for anesthetic care throughout the perioperative period. This article reviews pharmacology, safety concerns, and perioperative considerations for patients who receive oral 5-ALA.Recent findings: Although approved for clinical use by the United States Food and Drug Administration in 2017, studies and case reports published since then have further delineated side effects of this medication and its mechanisms and pharmacokinetics.Summary: Mitigating the possible side effects of 5-ALA requires an understanding of its basic mechanism as well as focused perioperative planning and communication. Administration of this medication may result in nausea, vomiting, photosensitivity, increase in serum concentration of liver enzymes, and hypotension. Patients who receive 5-ALA must be protected from prolonged light exposure during the first 48 h after consumption and administration of other photosensitizing agents should be avoided (Supplemental Video File/Video abstract).","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"446-452"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621662","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

Postoperative pain management after abdominal transplantations. 腹腔移植术后疼痛管理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-05-21 DOI: 10.1097/ACO.0000000000001389

Boris Tufegdzic, Clara Lobo, Arun Kumar

{"title":"Postoperative pain management after abdominal transplantations.","authors":"Boris Tufegdzic, Clara Lobo, Arun Kumar","doi":"10.1097/ACO.0000000000001389","DOIUrl":"10.1097/ACO.0000000000001389","url":null,"abstract":"Purpose of review: The aim of this review article is to present current recommendations as well as knowledge gaps and controversies pertaining to commonly utilized postoperative pain management after solid organ transplantation in the abdominal cavity.Recent findings: Postsurgical pain has been identified as one of the major challenges in recovery and treatment after solid organ transplants. Many perioperative interventions and management strategies are available for reducing and managing postoperative pain. Management should be tailored to the individual needs, taking an interdisciplinary and holistic approach and following enhanced recovery after surgery guidelines. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures.Summary: The optimal pain management regimen has not yet been definitively established, and current scientific evidence does not yet support the endorsement of a certain analgesic approach. This objective necessitates the need for high-quality randomized controlled trials.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"504-512"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263510","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

Neurologic disease in the obstetric patient. 产科病人的神经系统疾病。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-11 DOI: 10.1097/ACO.0000000000001405

Konstantin Inozemtsev, Evelyn Yeh, Ned F Nasr

引用次数: 0

Optimizing peripheral regional anaesthesia: strategies for single shot and continuous blocks. 优化外周区域麻醉：单次阻滞和连续阻滞的策略。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-24 DOI: 10.1097/ACO.0000000000001407

David Johnstone, Alasdair Taylor, Jenny Ferry

{"title":"Optimizing peripheral regional anaesthesia: strategies for single shot and continuous blocks.","authors":"David Johnstone, Alasdair Taylor, Jenny Ferry","doi":"10.1097/ACO.0000000000001407","DOIUrl":"10.1097/ACO.0000000000001407","url":null,"abstract":"Purpose of review: Regional anaesthesia is increasingly prominent within anaesthesia, offering alternative analgesic options amidst concerns over opioid-based analgesia. Since Halsted's initial description, the field has burgeoned, with ultrasound visualization revolutionizing local anaesthetic spread assessment, leading to the development of numerous novel techniques. The benefits of regional anaesthesia have gained increasing evidence to support their application, leading to changes within training curricula. Consequently, regional anaesthesia is at a defining moment, embracing the development of core skills for the general anaesthesiologist, whilst also continuing the advancement of the specialty.Recent findings: Recent priority setting projects have focussed attention on key aspects of regional anaesthesia delivery, including pain management, conduct and efficacy, education, and technological innovation. Developments in our current understanding of anatomy and pharmacology, combined with strategies for optimizing the conduct and maximizing efficacy of techniques, minimizing complications, and enhancing outcomes are explored. In addition, advancements in education and training methodologies and the integration of progress in novel technologies will be reviewed.Summary: This review highlights recent scientific advances in optimizing both single-shot and continuous peripheral regional anaesthesia techniques. By synthesizing these developments, this review offers valuable insights into the evolving landscape of regional anaesthesia, aiming to improve clinical practice and patient care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"541-546"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621667","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

Fascial plane blocks: from microanatomy to clinical applications. 筋膜平面阻滞：从微观解剖到临床应用。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI: 10.1097/ACO.0000000000001416

Carmelo Pirri, Debora Emanuela Torre, Carla Stecco

{"title":"Fascial plane blocks: from microanatomy to clinical applications.","authors":"Carmelo Pirri, Debora Emanuela Torre, Carla Stecco","doi":"10.1097/ACO.0000000000001416","DOIUrl":"10.1097/ACO.0000000000001416","url":null,"abstract":"Purpose of review: In the last 20 years, advancements in the understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) have gained popularity due to their validated safety profile and relative ease. They are used in various clinical settings for surgical and nonsurgical indications. Growing evidence suggests a link between the microscopic anatomy of fasciae and their mechanism of action. As a result, knowledge of these aspects is urgently needed to better optimise pain management. The purpose of this review is to summarise the different microscopic aspects of deep/muscular fascia to expand our understanding in the performance of FPBs.Recent findings: There is ample evidence to support the role of FPBs in pain management. However, the exact mechanism of action remains unclear. Fasciae are composed of various structural elements and display complex anatomical characteristics at the microscopic level. They include various cell types embedded within an extracellular matrix abundant in collagens and hyaluronan. Increasingly, numerous studies demonstrated their innervation that contributes to their sensory functions and their role in proprioception, motor coordination and pain perception. Lastly, the diversity of the cellular and extracellular matrix, with their viscoelastic properties, is essential to understanding the FPBs' mechanism of action.Summary: Physicians must be aware of the role of fascial microscopic anatomy and better understand their properties to perform FPBs in a conscious manner and enhance pain management.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"526-532"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11356744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898826","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

Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia. 重症监护创新：重症监护中的镇痛导航：区域麻醉的作用。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-08 DOI: 10.1097/aco.0000000000001422

Amber Campbell,Mackenzie Jacoby,Nadia Hernandez

引用次数: 0

Why sedative hypnotics often fail in development. 镇静催眠药为何常常研发失败？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-03 DOI: 10.1097/ACO.0000000000001381

J Robert Sneyd

引用次数: 0

Artificial intelligence and nonoperating room anesthesia. 人工智能与非手术室麻醉。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-16 DOI: 10.1097/ACO.0000000000001388

Emmanuel Pardo, Elena Le Cam, Franck Verdonk

{"title":"Artificial intelligence and nonoperating room anesthesia.","authors":"Emmanuel Pardo, Elena Le Cam, Franck Verdonk","doi":"10.1097/ACO.0000000000001388","DOIUrl":"10.1097/ACO.0000000000001388","url":null,"abstract":"Purpose of review: The integration of artificial intelligence (AI) in nonoperating room anesthesia (NORA) represents a timely and significant advancement. As the demand for NORA services expands, the application of AI is poised to improve patient selection, perioperative care, and anesthesia delivery. This review examines AI's growing impact on NORA and how it can optimize our clinical practice in the near future.Recent findings: AI has already improved various aspects of anesthesia, including preoperative assessment, intraoperative management, and postoperative care. Studies highlight AI's role in patient risk stratification, real-time decision support, and predictive modeling for patient outcomes. Notably, AI applications can be used to target patients at risk of complications, alert clinicians to the upcoming occurrence of an intraoperative adverse event such as hypotension or hypoxemia, or predict their tolerance of anesthesia after the procedure. Despite these advances, challenges persist, including ethical considerations, algorithmic bias, data security, and the need for transparent decision-making processes within AI systems.Summary: The findings underscore the substantial benefits of AI in NORA, which include improved safety, efficiency, and personalized care. AI's predictive capabilities in assessing hypoxemia risk and other perioperative events, have demonstrated potential to exceed human prognostic accuracy. The implications of these findings advocate for a careful yet progressive adoption of AI in clinical practice, encouraging the development of robust ethical guidelines, continual professional training, and comprehensive data management strategies. Furthermore, AI's role in anesthesia underscores the need for multidisciplinary research to address the limitations and fully leverage AI's capabilities for patient-centered anesthesia care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"37 4","pages":"413-420"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460574","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