Current Opinion in Anesthesiology最新文献_第10页

The way towards ethical anesthesia care: no aim - no game - no fame or blame? 实现道德麻醉护理的途径：无目的-无游戏-无名誉或指责？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI: 10.1097/ACO.0000000000001391

Basak Ceyda Meco, Cigdem Yildirim Guclu, Joana Berger-Estilita, Finn M Radtke

{"title":"The way towards ethical anesthesia care: no aim - no game - no fame or blame?","authors":"Basak Ceyda Meco, Cigdem Yildirim Guclu, Joana Berger-Estilita, Finn M Radtke","doi":"10.1097/ACO.0000000000001391","DOIUrl":"10.1097/ACO.0000000000001391","url":null,"abstract":"Purpose of review: This review explores the intricacies of ethical anesthesia, exploring the necessity for precision anesthesia and its impact on patient-reported outcomes. The primary objective is to advocate for a defined aim, promoting the implementation of rules and feedback systems. The ultimate goal is to enhance precision anesthesia care, ensuring patient safety through the implementation of a teamwork and the integration of feedback mechanisms.Recent findings: Recent strategies in the field of anesthesia have evolved from intraoperative monitorization to a wider perioperative patient-centered precision care. Nonetheless, implementing this approach encounters significant obstacles. The article explores the evidence supporting the need for a defined aim and applicable rules for precision anesthesia's effectiveness. The implementation of the safety culture is underlined. The review delves into the teamwork description with structured feedback systems.Summary: Anesthesia is a multifaceted discipline that involves various stakeholders. The primary focus is delivering personalized precision care. This review underscores the importance of establishing clear aims, defined rules, and fostering effective and well tolerated teamwork with accurate feedback for improving patient-reported outcomes. The Safe Brain Initiative approach, emphasizing algorithmic monitoring and systematic follow-up, is crucial in implementing a fundamental and standardized reporting approach within patient-centered anesthesia care practice.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"432-438"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260385","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

Remimazolam: its clinical pharmacology and evolving role in anesthesia and sedation practice. 雷马唑仑：其临床药理学及其在麻醉和镇静实践中不断发展的作用。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-07 DOI: 10.1097/ACO.0000000000001384

Kenichi Masui

{"title":"Remimazolam: its clinical pharmacology and evolving role in anesthesia and sedation practice.","authors":"Kenichi Masui","doi":"10.1097/ACO.0000000000001384","DOIUrl":"10.1097/ACO.0000000000001384","url":null,"abstract":"Purpose of review: Remimazolam is a novel benzodiazepine anesthetic/sedative, designed as a rapidly metabolized carboxylic acid. Since its recent launch, the role of remimazolam in modern anesthesia and sedation practice is still evolving. This review aims to outline the clinical pharmacology and clinical utility of remimazolam to elucidate its potential advantages and limitations.Recent findings: Remimazolam is \"short-acting\" but not ultra-short-acting compared with propofol based on context-sensitive decrement times. But compared to propofol, the availability of the benzodiazepine antagonist, flumazenil, is considered an advantage, particularly in certain emergency situations such as in patients with difficult airways. However, because flumazenil is shorter acting than remimazolam when remimazolam accumulates or is present in a high concentration, the reappearance of remimazolam sedation may occur after the initial reversal of anesthesia/sedation from flumazenil administration. Although it is beneficial that remimazolam causes less respiratory depression and hypotension than propofol, serious respiratory depression and hypotension can still occur. Remimazolam administration causes minimal or no pain on injection. Remimazolam is associated with less postoperative nausea and vomiting than inhaled anesthetics, but propofol is clearly superior in this regard. The anesthetic/sedative effects may be prolonged by severe hepatic impairment; remimazolam tolerance can occur in long-term benzodiazepine users.Summary: Remimazolam may be beneficial to use in procedural sedation and general anesthesia for patients with difficult airways or hemodynamic instability. Further clinical studies with remimazolam are warranted to identify the potential benefits in other settings and patient populations.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"344-351"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263513","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

Patient selection for nonoperating room anesthesia. 非手术室麻醉的病人选择。

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.0000000000001382

Paige L Georgiadis, Mitchell H Tsai, Justin S Routman

{"title":"Patient selection for nonoperating room anesthesia.","authors":"Paige L Georgiadis, Mitchell H Tsai, Justin S Routman","doi":"10.1097/ACO.0000000000001382","DOIUrl":"10.1097/ACO.0000000000001382","url":null,"abstract":"Purpose of review: Given the rapid growth of nonoperating room anesthesia (NORA) in recent years, it is essential to review its unique challenges as well as strategies for patient selection and care optimization.Recent findings: Recent investigations have uncovered an increasing prevalence of older and higher ASA physical status patients in NORA settings. Although closed claim data regarding patient injury demonstrate a lower proportion of NORA cases resulting in a claim than traditional operating room cases, NORA cases have an increased risk of claim for death. Challenges within NORA include site-specific differences, limitations in ergonomic design, and increased stress among anesthesia providers. Several authors have thus proposed strategies focusing on standardizing processes, site-specific protocols, and ergonomic improvements to mitigate risks.Summary: Considering the unique challenges of NORA settings, meticulous patient selection, risk stratification, and preoperative optimization are crucial. Embracing data-driven strategies and leveraging technological innovations (such as artificial intelligence) is imperative to refine quality control methods in targeted areas. Collaborative efforts led by anesthesia providers will ensure personalized, well tolerated, and improved patient outcomes across all phases of NORA care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"406-412"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263508","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

Place of high-flow nasal oxygen in nonoperating room anesthesia. 在非手术室麻醉中使用高流量鼻氧。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-04-30 DOI: 10.1097/ACO.0000000000001383

Mai-Anh Nay, Adrien Auvet

{"title":"Place of high-flow nasal oxygen in nonoperating room anesthesia.","authors":"Mai-Anh Nay, Adrien Auvet","doi":"10.1097/ACO.0000000000001383","DOIUrl":"10.1097/ACO.0000000000001383","url":null,"abstract":"Purpose of review: This article aims to assess the utility of high-flow nasal oxygen (HFNO) therapy in nonoperating room anesthesia (NORA) settings.Recent findings: The number of procedural interventions under deep sedation in NORA is still increasing. Administration of oxygen is recommended to prevent hypoxemia and is usually delivered with standard oxygen through nasal cannula or a face mask. HFNO is a simple alternative with a high warmed humidified flow (ranging from 30 to 70 l/min) with a precise fraction inspired of oxygen (ranging from 21 to 100%). Compared to standard oxygen, HFNO has demonstrated efficacy in reducing the incidence of hypoxemia and the need for airway maneuvers. Research on HFNO has primarily focused on its application in gastrointestinal endoscopy procedures. Yet, it has also shown promising results in various other procedural interventions including bronchoscopy, cardiology, and endovascular procedures. However, the adoption of HFNO prompted considerations regarding cost-effectiveness and environmental impact.Summary: HFNO emerges as a compelling alternative to conventional oxygen delivery methods for preventing hypoxemia during procedural interventions in NORA. However, its utilization should be reserved for patients at moderate-to-high risk to mitigate the impact of cost and environmental factors.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"421-426"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263509","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

Environmental impact of anesthetic drugs. 麻醉药物对环境的影响。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-06-04 DOI: 10.1097/ACO.0000000000001395

Diane W Gordon

{"title":"Environmental impact of anesthetic drugs.","authors":"Diane W Gordon","doi":"10.1097/ACO.0000000000001395","DOIUrl":"10.1097/ACO.0000000000001395","url":null,"abstract":"Purpose of review: The environmental impact of anesthesia far exceeds that of other medical specialties due to our use of inhaled anesthetic agents (which are potent greenhouse gases) and many intravenous medications.Recent findings: Calls for reducing the carbon footprint of anesthesia are ubiquitous in the anesthesia societies of developed nations and are appearing in proposed changes for hospital accreditation and funding in the United States. The body of research on atmospheric, land and water impacts of anesthetic pharmaceuticals is growing and generally reinforces existing recommendations to reduce the greenhouse gas emissions of anesthesia care.Summary: The environmental impact of anesthesia care should factor into our clinical decisions. The onus is on clinicians to safely care for our patients in ways that contribute the least harm to the environment. Intravenous anesthesia and regional techniques have less environmental impact than the use of inhaled agents; efforts to reduce and properly dispose of pharmaceutical waste are central to reducing environmental burden; desflurane should not be used; nitrous oxide should be avoided except where clinically necessary; central nitrous pipelines should be abandoned; low fresh gas flows should be utilized whenever inhaled agents are used.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"379-383"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263505","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

Long-term intravenous devices: a narrative review of their placement. 长期静脉注射装置：对其安置情况的叙述性回顾。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-13 DOI: 10.1097/ACO.0000000000001387

Sabine Roche

引用次数: 0

Opioid-free general anesthesia: considerations, techniques, and limitations. 无阿片全身麻醉：考虑因素、技术和局限性。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-09 DOI: 10.1097/ACO.0000000000001385

Harsha Shanthanna, Girish P Joshi

{"title":"Opioid-free general anesthesia: considerations, techniques, and limitations.","authors":"Harsha Shanthanna, Girish P Joshi","doi":"10.1097/ACO.0000000000001385","DOIUrl":"10.1097/ACO.0000000000001385","url":null,"abstract":"Purpose of review: To discuss the role of opioids during general anesthesia and examine their advantages and risks in the context of clinical practice. We define opioid-free anesthesia (OFA) as the absolute avoidance of intraoperative opioids.Recent findings: In most minimally invasive and short-duration procedures, nonopioid analgesics, analgesic adjuvants, and local/regional analgesia can significantly spare the amount of intraoperative opioid needed. OFA should be considered in the context of tailoring to a specific patient and procedure, not as a universal approach. Strategies considered for OFA involve several adjuncts with low therapeutic range, requiring continuous infusions and resources, with potential for delayed recovery or other side effects, including increased short-term and long-term pain. No evidence indicates that OFA leads to decreased long-term opioid-related harms.Summary: Complete avoidance of intraoperative opioids remains questionable, as it does not necessarily ensure avoidance of postoperative opioids. Multimodal analgesia including local/regional anesthesia may allow OFA for selected, minimally invasive surgeries, but further research is necessary in surgeries with high postoperative opioid requirements. Until there is definitive evidence regarding procedure and patient-specific combinations as well as the dose and duration of administration of adjunct agents, it is imperative to practice opioid-sparing approach in the intraoperative period.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"384-390"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263507","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

Sugammadex and oral contraceptives. 舒降之和口服避孕药。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI: 10.1097/ACO.0000000000001397

Tamblyn Devoy, Natalie Smith

{"title":"Sugammadex and oral contraceptives.","authors":"Tamblyn Devoy, Natalie Smith","doi":"10.1097/ACO.0000000000001397","DOIUrl":"10.1097/ACO.0000000000001397","url":null,"abstract":"Purpose of review: This review article explores the evidence regarding sugammadex (MSD Australia) and its potential interaction with hormonal contraceptives. The impact of recent clinical trials and review articles is examined.Recent findings: Recent clinical data suggest that the interaction between sugammadex and estrogen and progesterone concentrations may not be clinically significant and may confer some protection against ovulation. There are no clinical trials reporting interactions between sugammadex and the exogenous hormonal compounds found in oral contraceptive pills. The method of contraception is an important consideration, as sugammadex theoretically affects oral and nonoral, and combined versus single agent methods differently. Two large retrospective database studies have reported two cases of pregnancy postoperatively in patients on hormonal contraceptives whose anesthetic included sugammadex.Summary: Strong clinical evidence to support or refute claims of a significant impact of sugammadex on contraceptive efficacy in women on contraception is lacking. The existing evidence does not suggest a basis for concern regarding the impact of sugammadex on contraception in the perioperative setting.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"338-343"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260340","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

Progress in the validation of nociception monitoring in guiding intraoperative analgesic therapy. 验证痛觉监测在指导术中镇痛治疗方面的进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI: 10.1097/ACO.0000000000001390

Hendrik Van Santvliet, Hugo E M Vereecke

{"title":"Progress in the validation of nociception monitoring in guiding intraoperative analgesic therapy.","authors":"Hendrik Van Santvliet, Hugo E M Vereecke","doi":"10.1097/ACO.0000000000001390","DOIUrl":"10.1097/ACO.0000000000001390","url":null,"abstract":"Purpose of review: This article summarizes the current level of validation for several nociception monitors using a categorized validation process to facilitate the comparison of performance.Recent findings: Nociception monitors improve the detection of a shift in the nociception and antinociception balance during anesthesia, guiding perioperative analgesic therapy. A clear overview and comparison of the validation process for these monitors is missing.Results: Within a 2-year time-frame, we identified validation studies for four monitors [analgesia nociception index (ANI), nociception level monitor (NOL), surgical pleth index (SPI), and pupillometry]. We categorized these studies in one out of six mandatory validation steps: developmental studies, clinical validation studies, pharmacological validation studies, clinical utility studies, outcome improvement studies and economical evaluation studies. The current level of validation for most monitors is mainly focused on the first three categories, whereas ANI, NOL, and SPI advanced most in the availability of clinical utility studies and provide confirmation of a clinical outcome improvement. Analysis of economical value for public health effects is not yet publicly available for the studied monitors.Summary: This review proposes a stepwise structure for validation of new monitoring technology, which facilitates comparison between the level of validation of different devices and identifies the need for future research questions.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"352-361"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263511","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 gender-affirming surgery: a practical review. 性别确认手术的麻醉：实用综述。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-06-01 Epub Date: 2024-02-21 DOI: 10.1097/ACO.0000000000001366

Kyle Sanchez, Luis Tollinche, Travis Reece-Nguyen

引用次数: 0