Current Opinion in Anesthesiology最新文献_第2页

Ethics of consenting the 'unconsentable'. 同意“不同意”的伦理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-02-28 DOI: 10.1097/ACO.0000000000001480

Shahla Siddiqui

引用次数: 0

Pediatric trauma and resuscitation: optimizing care in an evolving landscape. 儿科创伤和复苏：在不断变化的环境中优化护理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-03-14 DOI: 10.1097/ACO.0000000000001484

Carl L McMullen, David Levin, Asheen Rama

{"title":"Pediatric trauma and resuscitation: optimizing care in an evolving landscape.","authors":"Carl L McMullen, David Levin, Asheen Rama","doi":"10.1097/ACO.0000000000001484","DOIUrl":"10.1097/ACO.0000000000001484","url":null,"abstract":"Purpose of review: Penetrating firearm-related injury has increased mortality rates in children in the USA. This article summarizes trends in pediatric injury patterns, the unique coagulation system of infants, and key components of hemostatic resuscitation in children.Recent findings: Firearm-associated penetrating trauma increased mortality and led to higher rates of pediatric massive transfusions. Patients may be the victim of previous gun violence or live with an adult who purchased a firearm for the first time during the COVID-19 pandemic. Platelet dysfunction and hypocalcemia are important considerations that may lead to higher transfusion requirements if not addressed. Pediatric massive transfusion protocols have become more standardized, and the use of whole blood has increased. Low-titer group O whole blood has shown benefit to improve coagulopathy and shock-associated indices when compared with conventional component therapy.Summary: Traumatic hemorrhage is potentially life-threatening in children and requires prompt hemostatic resuscitation. Massive transfusion protocols that target trauma-induced coagulopathy and account for the unique pediatric coagulation system are imperative. Ongoing and future research is important to standardize pediatric resuscitation practices.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"247-252"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626743","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

Neuraxial initiation techniques for labor analgesia: Comparative insights on standard epidural, combined spinal-epidural and dural puncture epidural analgesia. 分娩镇痛的轴向启动技术：标准硬膜外、脊髓-硬膜外联合和硬膜穿刺硬膜外镇痛的比较研究。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-03-25 DOI: 10.1097/ACO.0000000000001487

Anthony Chau, Lawrence C Tsen

{"title":"Neuraxial initiation techniques for labor analgesia: Comparative insights on standard epidural, combined spinal-epidural and dural puncture epidural analgesia.","authors":"Anthony Chau, Lawrence C Tsen","doi":"10.1097/ACO.0000000000001487","DOIUrl":"10.1097/ACO.0000000000001487","url":null,"abstract":"Purpose of review: In recent years, initiation techniques for neuraxial labor analgesia have focused on enhancing analgesic quality while minimizing complications. This review aims to summarize recent evidence on the standard epidural (EPL), combined spinal-epidural (CSE), and dural puncture epidural (DPE) techniques, emphasizing their benefits, risks, and relevance in contemporary obstetric anesthesia care.Recent findings: The DPE technique offers unique values, combining the advantages from CSE and EPL techniques. DPE and CSE, compared with EPL, techniques involve a dural puncture with a spinal needle, and the resulting epidural-intrathecal conduit enables translocation of analgesic agents, providing faster onset, earlier sacral coverage, better catheter function, and more rapid epidural extension to surgical anesthesia. Moreover, by limiting the intrathecal dose administered with the CSE technique, the DPE technique lowers the risks of fetal bradycardia and pruritus.Summary: EPL and CSE techniques are widely used for neuraxial labor analgesia. The DPE technique offers a novel alternative, delivering high-quality analgesia with minimal complications. While the benefits of the DPE technique are increasingly being recognized, additional comparative research will better support anesthesiologists in selecting the most appropriate technique across diverse clinical scenarios.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"195-201"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744350","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 pediatric organ transplantation, current concepts. 儿童器官移植的麻醉，目前的概念。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-04-07 DOI: 10.1097/ACO.0000000000001491

Scott Licata, Brian Blasiole, Mihaela Visoiu, Daniela Damian

{"title":"Anesthesia for pediatric organ transplantation, current concepts.","authors":"Scott Licata, Brian Blasiole, Mihaela Visoiu, Daniela Damian","doi":"10.1097/ACO.0000000000001491","DOIUrl":"10.1097/ACO.0000000000001491","url":null,"abstract":"Purpose of review: Although less common than in adults, pediatric organ transplantation has seen significant recent innovations in surgical techniques, perioperative management, and postoperative outcomes. These advances, which we will delve into in this review, are at the forefront of improving the survival and quality of life of pediatric transplant recipients.Recent findings: Advances in donor utilization (e.g. donation after circulatory death and split-liver grafts) and surgical approaches (partial heart transplants and novel multiorgan procedures) have expanded the donor pool and enhanced graft viability. Improved perioperative care, including refined anesthetic monitoring, fluid management, and immediate extubation, reduces the incidence of complications. Research into model-informed precision dosing for antibiotics addresses under- or overdosing in critically ill children, whereas emerging immunosuppressants offer potential benefits over conventional regimens. Nonetheless, coagulopathy, hemodynamic instability, and developmental variations remain major challenges.Summary: Optimization of pediatric transplantation is a complex task that requires multidisciplinary collaboration. This review underscores the importance of standardizing perioperative protocols, advancing precision medicine, and refining surgical and anesthetic techniques. It also highlights the need for dedicated pediatric transplant registries and multicenter trials to generate robust data, minimize practice variability, and improve outcomes.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"230-235"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056272","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

Pain during cesarean delivery: risk factors, mitigation, and current approaches. 剖宫产疼痛：危险因素、缓解和当前方法

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-04-01 DOI: 10.1097/ACO.0000000000001488

Emily E Sharpe, Ruth Landau

{"title":"Pain during cesarean delivery: risk factors, mitigation, and current approaches.","authors":"Emily E Sharpe, Ruth Landau","doi":"10.1097/ACO.0000000000001488","DOIUrl":"10.1097/ACO.0000000000001488","url":null,"abstract":"Purpose of review: Pain during cesarean delivery (PDCD) has been overlooked and underreported and is associated with a traumatic birth experience and long-term morbidity. We review the studies reporting on PDCD and summarize available guidance providing roadmaps for anesthesiologists caring for patients during cesarean delivery.Recent findings: PDCD is a patient-reported outcome and should not be defined by interventions mitigating insufficient neuraxial anesthesia, such as supplemental analgesic medication or general anesthesia. Depending on the cohorts studied and definitions used, current reported rates of PDCD range between 2 and 36%. Preoperative patient counseling, risk stratification, and testing of neuraxial block are mitigating strategies; ultimately, if pain occurs, it should be managed skillfully applying shared decision-making with a supportive follow-up to reduce psychological trauma. Statements from three international organizations offer guidance to prevent and treat PDCD.Summary: This review provides strategies to mitigate the occurrence of PDCD, with targeted approaches to better prevent and manage PDCD.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"169-178"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755750","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. 产科麻醉师在新生儿复苏方面的进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub 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":"208-214"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","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

Regional anesthesia for arrhythmias: a review of current literature. 局部麻醉治疗心律失常：当前文献综述。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-02-28 DOI: 10.1097/ACO.0000000000001479

Monica Daswani, Amit Aggarwal, Richesh Guragain

{"title":"Regional anesthesia for arrhythmias: a review of current literature.","authors":"Monica Daswani, Amit Aggarwal, Richesh Guragain","doi":"10.1097/ACO.0000000000001479","DOIUrl":"10.1097/ACO.0000000000001479","url":null,"abstract":"Purpose of the review: The aim is to provide a comprehensive review of regional anesthesia techniques to control ventricular arrhythmias.Recent findings: While promising, the use of stellate ganglion block (SGB) for arrhythmia control is still under investigation, and further clinical trials are warranted to fully understand its efficacy, long-term outcomes, suitable patient group, and safety profile. Nevertheless, it remains a potential adjunctive therapy in the management of ventricular arrhythmias in select patients. Continuous stellate ganglion block (C-SGB) offers an alternative to single-shot SGB and thoracic epidural anesthesia for effective management in the reduction of ventricular arrhythmias until definitive treatment; it is safe and may reduce the need to repeat the single-shot block.Summary: SGB has been described in the literature as a successful adjunct therapy to reduce arrhythmia load. Blocking the stellate ganglion can provide transient sympathetic blockade for controlling refractory ventricular arrhythmias, otherwise uncontrolled with medication management. By regulating the sympathetic nervous system, the stellate ganglion affects the electrical conductance of the heart, and thus inhibition of the ganglion can modulate the autonomic balance with subsequent reduction in ventricular arrhythmias. These studies until 2017 were limited to case reports and case series; meta-analysis by Fudim et al . supports the use of left-sided SGB to manage ventricular arrhythmias. Recent clinical trials further strengthen the findings and favor the trend of catheter use for continuous SGB. Further studies are warranted to identify suitable patient groups and when to initiate SBG or C-SGB.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"310-315"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607126","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

Coaching in residency training programs: moving toward learner-centered education in anesthesiology. 指导住院医师培训计划：向以学习者为中心的麻醉学教育迈进。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-04-28 DOI: 10.1097/ACO.0000000000001483

Sydney Nykiel-Bailey

{"title":"Coaching in residency training programs: moving toward learner-centered education in anesthesiology.","authors":"Sydney Nykiel-Bailey","doi":"10.1097/ACO.0000000000001483","DOIUrl":"10.1097/ACO.0000000000001483","url":null,"abstract":"Purpose of review: The review provides a comprehensive analysis of coaching within residency training programs, with a focus on examining foundational theoretical frameworks, exploring implementation strategies, and evaluating the impacts on learner competencies and overall well-being. The analysis aims to bridge gaps in the current lack of anesthesiology coaching literature and provide evidence-based insights to optimize the role of coaching in medical education and professional development.Recent findings: Coaching programs emphasize learner-centered education and the facilitation of professional growth. This review examines various coaching models, including communication-focused coaching, near-peer coaching, and the PRACTICE framework. The successful implantation of these models requires tailoring to the learner group to mitigate challenges and optimize acquisition of competencies, such as enhanced technical proficiency and communication skills. Evidence from coaching programs in nonanesthesiology specialties highlights their adaptability and potential applicability to the training of anesthesiology residents.Summary: Coaching programs in medical education show promise for adaption to anesthesiology, addressing its unique demands. Tailored approaches can improve technical skills, communication, and resident well-being. Embedding coaching within competency-based frameworks, tied to milestones and entrustable professional activities supports professional development and educational goals. Successful implantation depends on faculty training, interdepartmental collaboration, and ongoing evaluation, ensuring that coaching programs enhance resident performance and ultimately improve patient outcomes.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"236-241"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626742","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

Recent advancements in fetal anesthesia. 胎儿麻醉的最新进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-04-01 DOI: 10.1097/ACO.0000000000001490

Megan Dewey, Preeta George

引用次数: 0

Anesthetic considerations in cancer care. 癌症治疗中的麻醉考虑。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-06-01 Epub Date: 2025-03-14 DOI: 10.1097/ACO.0000000000001475

Adebukola Owolabi, Edward Tsai

{"title":"Anesthetic considerations in cancer care.","authors":"Adebukola Owolabi, Edward Tsai","doi":"10.1097/ACO.0000000000001475","DOIUrl":"10.1097/ACO.0000000000001475","url":null,"abstract":"Purpose of review: Cancer burden remains a global medical and financial challenge. Advances in surgical management have resulted in increased oncological surgeries that often involve anesthetic administration. This review aims to inform on anesthetic considerations when caring for cancer patients in the perioperative period.Recent findings: There are various retrospective studies and, more recently, several randomized controlled trials that have explored whether the choice of anesthesia (total intravenous anesthesia vs. inhaled anesthetic) results in a significant difference in cancer outcomes, mortality, cancer recurrence, and metastasis. To date, no definitive proof has been made, and the current conclusion remains that the anesthetic technique does not influence survival or overall long-term outcomes.Summary: Comprehensive risk assessment is essential in cancer patients before elective surgeries due to a variety of concerns such as malnutrition, aspiration risk, postradiation airway compromise, and antineoplastic systemic effects. Oncologic patients' exposure to chemotherapy and radiation causes immunosuppression and multiorgan toxicity that places them at increased perioperative risk for morbidity and mortality. Other concerns include the challenges of adequate pain management and pre-existing chronic pain.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"287-293"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626741","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