Current Opinion in Anesthesiology最新文献_第2页

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 : 2025-04-01 Epub Date: 2025-02-14 DOI: 10.1097/ACO.0000000000001465

Marc Maegele

引用次数: 0

Editorial introductions.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-04-01 Epub Date: 2025-02-25 DOI: 10.1097/ACO.0000000000001458

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 : 2025-04-01 Epub 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":"120-128"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","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 : 2025-04-01 Epub 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":"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":"114-119"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","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

Neuraxial initiation techniques for labor analgesia: Comparative insights on standard epidural, combined spinal-epidural and dural puncture epidural analgesia.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub 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":"https://doi.org/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":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","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

Next generation of neuromuscular blockade reversal agents.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-03-25 DOI: 10.1097/ACO.0000000000001485

Hans D de Boer, Ricardo Vieira Carlos

{"title":"Next generation of neuromuscular blockade reversal agents.","authors":"Hans D de Boer, Ricardo Vieira Carlos","doi":"10.1097/ACO.0000000000001485","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001485","url":null,"abstract":"Purpose of the review: The purpose of this review is to explore emerging pharmacological strategies for neuromuscular blockade (NMB) reversal, focusing on their mechanisms of action, efficacy, and potential advantages over existing agents like sugammadex and neostigmine.Recent findings: Several novel reversal agents are under investigation: calabadions, synthetic molecular containers that effectively reverse aminosteroidal and benzylisoquinolinium neuromuscular blocking agents (NMBAs) with rapid clearance; l-cysteine adduction, a promising method for reversing ultrashort-acting NMBAs by accelerating metabolism; adamgammadex, a modified γ-cyclodextrin with improved binding to rocuronium and reduced hypersensitivity risks, showing noninferiority to sugammadex; acyclic cucurbit[n]urils, broad-spectrum reversal agents with superior water solubility and biocompatibility; and ClC-1 channel blockers, a novel approach that enhances muscle excitability rather than directly binding to NMBAs.Summary: Emerging NMBA reversal agents offer potential improvements in safety, efficacy, and broader NMBA compatibility. These alternatives to sugammadex and neostigmine show promise in preclinical and early clinical trials. Further studies are necessary to confirm their clinical applicability and regulatory approval.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744351","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

Pediatric enhanced recovery after surgery (ERAS): Advancements and outcomes in the last 5 years.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-03-25 DOI: 10.1097/ACO.0000000000001486

Megan A Brockel, Vidya T Raman

{"title":"Pediatric enhanced recovery after surgery (ERAS): Advancements and outcomes in the last 5 years.","authors":"Megan A Brockel, Vidya T Raman","doi":"10.1097/ACO.0000000000001486","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001486","url":null,"abstract":"Purpose of review: The aim is to describe recent advances in pediatric enhanced recovery after surgery (ERAS) in all phases of care as well as the outcomes and impact of recent evidenced-based pathways in pediatric patients.Recent findings: While profoundly impactful in the care of adult patients for nearly 3 decades, ERAS had a slower start in pediatric care that began approximately 10 years ago. Early outcomes were promising, and the multidisciplinary approach to perioperative care has gained momentum, with recent single-center studies of ERAS for pediatric patients showing reductions in both complications and length of stay. The first ERAS Society recommendations for pediatric patients were published in 2024, and two multicenter trials of pediatric ERAS, Pediatric urology recovery after surgery endeavor and ENhanced Recvovery in CHildren Undergoing Surgery (ENRICH-US), have completed enrollment and are expected to publish results in 2025.Summary: ERAS in pediatric practice has made great strides in the past 5 years and has led to improved outcomes for young patients. Multicenter trial outcomes and the development of additional rigorous ERAS Society recommendations for children will guide future care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744353","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

Pediatric trauma and resuscitation: optimizing care in an evolving landscape.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub 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":"https://doi.org/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":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","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

Coaching in residency training programs: moving toward learner-centered education in anesthesiology.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-03-14 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":"https://doi.org/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":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","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

Anesthetic considerations in cancer care.

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub 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":"https://doi.org/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":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","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