Current Opinion in Anesthesiology最新文献_第10页

Team-based care of the thoracic surgical patient. 胸外科病人的团队护理。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-29 DOI: 10.1097/ACO.0000000000001324

Charlie Slowey, Jake Abernathy

引用次数: 0

Temporary mechanical circulatory support & enhancing recovery after cardiac surgery. 临时机械循环支持和促进心脏手术后的恢复。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI: 10.1097/ACO.0000000000001332

Kevin W Lobdell, Michael C Grant, Rawn Salenger

引用次数: 0

A decade-long analysis of gender, race, and ethnic representation of incoming cardiothoracic anesthesiology fellows. 对新入职的心胸麻醉学研究员的性别、种族和民族代表性进行了长达十年的分析。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-12-07 DOI: 10.1097/ACO.0000000000001336

Jenna M Sesi, Meghan R Mansour, Roy G Soto

{"title":"A decade-long analysis of gender, race, and ethnic representation of incoming cardiothoracic anesthesiology fellows.","authors":"Jenna M Sesi, Meghan R Mansour, Roy G Soto","doi":"10.1097/ACO.0000000000001336","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001336","url":null,"abstract":"Purpose of review: This study calls attention to the necessity for increasing representation of minority groups among cardiothoracic fellowship programs.Recent findings: Demographics in medicine are changing, with more women and varying ethnicities contributing to the physician pool. Despite this change, diversity among cardiothoracic anesthesia fellows has not mirrored this trend.Summary: In November of 2022, medical student, anesthesia resident and cardiothoracic fellow demographics were analyzed from 2011 to 2021 to assess the changes in program diversity. Although male and female individuals have relatively similar representation in medical schools, female individuals only represent 34.8% of total US anesthesia residents. Cardiothoracic anesthesia fellowship programs continue to be male-sex dominant and white racial representation has consistently made up a majority of the total trainees. Increasing diversity amongst healthcare providers increases the likelihood of providing culturally competent care, thereby decreasing the healthcare gap in minority communities.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812960","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 the clinical use of patient-reported outcomes in thoracic surgery. 胸外科患者报告结果的临床应用进展。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-14 DOI: 10.1097/ACO.0000000000001326

Patrick Bou-Samra, Peter J Kneuertz

{"title":"Advances in the clinical use of patient-reported outcomes in thoracic surgery.","authors":"Patrick Bou-Samra, Peter J Kneuertz","doi":"10.1097/ACO.0000000000001326","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001326","url":null,"abstract":"Purpose of review: Patient-reported outcomes (PROs) are increasingly recognized as a clinical tool for measuring and improving patient-centric care. This review provides a summary on recent advances in the use of PROs in the field of thoracic surgery.Recent findings: PROs have been used as primary endpoints in clinical trials and observational studies evaluating clinical care pathways and quantifying the benefits of minimally invasive surgical techniques for patients undergoing lung surgery. Qualitative and quantitative research has yielded fundamental insights into which PRO domains are meaningful and valued by patients after lung surgery. Patient experience and recovery after esophagectomy have been further characterized by using PROs. New disease-specific survey tools for patients have been developed to track long-term symptoms after esophageal reconstruction. Patient satisfaction has emerged as the key metric used to gauge the patient centeredness of hospital systems.Summary: Advances have been made in the application of PROs in multiple areas of thoracic surgery, which include lung and esophageal surgery. The growing focus on the use of PROs in clinical pathways has led to a better understanding on how to optimize patient experience.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812961","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

Modern fluid management in thoracic surgery. 胸外科的现代液体管理。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-25 DOI: 10.1097/ACO.0000000000001333

Timothy J P Batchelor

{"title":"Modern fluid management in thoracic surgery.","authors":"Timothy J P Batchelor","doi":"10.1097/ACO.0000000000001333","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001333","url":null,"abstract":"Purpose of review: To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international guidelines on enhanced recovery after surgery (ERAS).Recent findings: The concern with intraoperative fluid management is that giving too little or too much fluid is associated with worse outcomes after lung resection. However, it has not emerged as a key care element in thoracic ERAS programs probably due to the influence of other ERAS elements. Carbohydrate loading 2 h before surgery and the allowance of water until just prior to induction ensures the patient is both well hydrated and metabolically normal when they enter the operating room. Consequently, maintaining a euvolemic state during anesthesia can be achieved without goal-directed fluid therapy despite the recommendations of some guidelines. Intravenous fluids can be safely stopped in the immediate postoperative period.Summary: The goal of perioperative euvolemia can be achieved with the ongoing evolution and application of ERAS principles. A focus on the pre and postoperative phases of fluid management and a pragmatic approach to intraoperative fluid management negates the need for goal-directed fluid therapy in most cases.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812970","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

Innovative designs for trials informing the care of cardiac surgical patients: part I. 为心脏外科患者护理提供信息的试验创新设计：第一部分。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-30 DOI: 10.1097/ACO.0000000000001335

Nikola Anusic, Daniel I Sessler

{"title":"Innovative designs for trials informing the care of cardiac surgical patients: part I.","authors":"Nikola Anusic, Daniel I Sessler","doi":"10.1097/ACO.0000000000001335","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001335","url":null,"abstract":"Purpose of review: Randomized clinical trials, now commonplace and regarded as top-tier evidence, are actually a recent development. The first randomized trial took place in 1948, just six decades ago. As anticipated from a relatively young field, rapid progress continues in response to an ever-increasing number of medical questions that demand answers. We examine evolving methodologies in cardiac anesthesia clinical trials, focusing on the transition towards larger sample sizes, increasing use of pragmatic trial designs, and the innovative adoption of real-time automated enrollment and randomization. We highlight how these changes enhance the reliability and feasibility of clinical trials.Recent findings: Recent understanding in clinical trial methodology acknowledges the importance of large sample sizes, which increase the reliability of findings. As illustrated by P value fragility, small trials can mislead despite statistical significance. Pragmatic trials have gained prominence, offering real-world insights into the effectiveness of various treatments. Additionally, the use of real-time automated enrollment and randomization, particularly in situations where obtaining prior consent is impractical, is an important methodological advance.Summary: The landscape of cardiac anesthesia clinical trials is rapidly evolving, with a clear trend towards large sample sizes and innovative approaches to enrollment. Recent developments enhance the quality and applicability of research findings, thus providing robust guidance to clinicians.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812966","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 nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians. 21世纪多模式麻醉的细节：临床医生的入门读物。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-09-19 DOI: 10.1097/ACO.0000000000001308

Friedrich Lersch, Paula Cruz Correia, Darren Hight, Heiko A Kaiser, Joana Berger-Estilita

{"title":"The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians.","authors":"Friedrich Lersch, Paula Cruz Correia, Darren Hight, Heiko A Kaiser, Joana Berger-Estilita","doi":"10.1097/ACO.0000000000001308","DOIUrl":"10.1097/ACO.0000000000001308","url":null,"abstract":"Purpose of review: This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes.Recent findings: Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain.Summary: The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96 ).","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10621648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41150502","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

The future of postoperative vital sign monitoring in general wards: improving patient safety through continuous artificial intelligence-enabled alert formation and reduction. 普通病房术后生命体征监测的未来：通过持续的人工智能提高患者安全，形成和减少警报。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-10-05 DOI: 10.1097/ACO.0000000000001319

Eske K Aasvang, Christian S Meyhoff

{"title":"The future of postoperative vital sign monitoring in general wards: improving patient safety through continuous artificial intelligence-enabled alert formation and reduction.","authors":"Eske K Aasvang, Christian S Meyhoff","doi":"10.1097/ACO.0000000000001319","DOIUrl":"10.1097/ACO.0000000000001319","url":null,"abstract":"Purpose: Monitoring of vital signs at the general ward with continuous assessments aided by artificial intelligence (AI) is increasingly being explored in the clinical setting. This review aims to describe current evidence for continuous vital sign monitoring (CVSM) with AI-based alerts - from sensor technology, through alert reduction, impact on complications, and to user-experience during implementation.Recent findings: CVSM identifies significantly more vital sign deviations than manual intermittent monitoring. This results in high alert generation without AI-evaluation, both in patients with and without complications. Current AI is at the rule-based level, and this potentially reduces irrelevant alerts and identifies patients at need. AI-aided CVSM identifies complications earlier with reduced staff workload and a potential reduction of severe complications.Summary: The current evidence for AI-aided CSVM suggest a significant role for the technology in reducing the constant 10-30% in-hospital risk of severe postoperative complications. However, large, randomized trials documenting the benefit for patient improvements are still sparse. And the clinical uptake of explainable AI to improve implementation needs investigation.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684503","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

In control or along for the ride? Lessons for anesthesiologists from air traffic control. 掌控还是顺风车？空中交通管制给麻醉师的教训。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-06-28 DOI: 10.1097/ACO.0000000000001289

Keith J Ruskin, Richard P Dutton, Anna Clebone Ruskin

{"title":"In control or along for the ride? Lessons for anesthesiologists from air traffic control.","authors":"Keith J Ruskin, Richard P Dutton, Anna Clebone Ruskin","doi":"10.1097/ACO.0000000000001289","DOIUrl":"10.1097/ACO.0000000000001289","url":null,"abstract":"Purpose of review: Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways.Recent findings: The increasing complexity of the healthcare environment suggests that the complete elimination of human error is not possible. Complex clinical situations predispose to errors that are the result of high workload, decision making under stress, and poor team coordination. The theory behind complex adaptive systems differs from medicine's traditional approach to safety and highlights the importance of an institutional safety culture that encourages flexibility, adaptability, reporting and learning from errors. Instead of focusing on standardization and strict adherence to procedures, clinicians can improve safety by recognizing that unpredictable changes routinely occur in the work environment and learning how resilience can prevent adverse events.Summary: A better understanding of automation, complexity, and resilience in a changing environment are essential steps toward the safe practice of anesthesia.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9956920","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

Quality indicators and outcomes in ambulatory surgery. 门诊手术的质量指标和结果。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-08-02 DOI: 10.1097/ACO.0000000000001304

Lena Glowka, Anthony Tanella, Jaime B Hyman

{"title":"Quality indicators and outcomes in ambulatory surgery.","authors":"Lena Glowka, Anthony Tanella, Jaime B Hyman","doi":"10.1097/ACO.0000000000001304","DOIUrl":"10.1097/ACO.0000000000001304","url":null,"abstract":"Purpose of review: Quality indicators are used to monitor the quality and safety of care in ambulatory surgery, a specialty in which major morbidity and mortality remain low. As the demand for safe and cost-effective ambulatory surgical care continues to increase, quality indicators and metrics are becoming critical tools used to provide optimal care for these patients.Recent findings: Quality indicators are tools used by both regulatory agencies and surgical centers to improve safety and quality of ambulatory surgical and anesthetic care. These metrics are also being used to develop value-based payment models that focus on efficient, safe, and effective patient care. Patient reported outcome measures are a growing method of collecting data on the satisfaction and postoperative recovery period for ambulatory surgical patients. Monitoring of perioperative efficiency and utilization using quality metrics are important to the financial health of ambulatory surgical centers.Summary: Quality indicators will continue to play a growing role in the monitoring of quality and safety in ambulatory surgery, especially with the trend towards value-based reimbursement models and efficient, cost-effective surgical care. Additionally, quality indicators are useful tools to monitor postoperative patient outcomes and recovery pathways and the efficiency of operating room utilization and scheduling.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693561","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