Current Opinion in Anesthesiology最新文献_第2页

Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis. 对近期接受非急诊、非神经、非心脏、非血管手术的中风患者的围手术期护理：系统综述和荟萃分析。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-10 DOI: 10.1097/ACO.0000000000001403

Abhijit V Lele, Elizabeth Olive Moreton, Jayashree Sundararajan, Samuel Neal Blacker

{"title":"Perioperative care of patients with recent stroke undergoing nonemergent, nonneurological, noncardiac, nonvascular surgery: a systematic review and meta-analysis.","authors":"Abhijit V Lele, Elizabeth Olive Moreton, Jayashree Sundararajan, Samuel Neal Blacker","doi":"10.1097/ACO.0000000000001403","DOIUrl":"10.1097/ACO.0000000000001403","url":null,"abstract":"Purpose of review: To systematically review and perform a meta-analysis of published literature regarding postoperative stroke and mortality in patients with a history of stroke and to provide a framework for preoperative, intraoperative, and postoperative care in an elective setting.Recent findings: Patients with nonneurological, noncardiac, and nonvascular surgery within three months after stroke have a 153-fold risk, those within 6 months have a 50-fold risk, and those within 12 months have a 20-fold risk of postoperative stroke. There is a 12-fold risk of in-hospital mortality within three months and a three-to-four-fold risk of mortality for more than 12 months after stroke. The risk of stroke and mortality continues to persist years after stroke. Recurrent stroke is common in patients in whom anticoagulation/antiplatelet therapy is discontinued. Stroke and time elapsed after stroke should be included in the preoperative assessment questionnaire, and a stroke-specific risk assessment should be performed before surgical planning is pursued.Summary: In patients with a history of a recent stroke, anesthesiology, surgery, and neurology experts should create a shared mental model in which the patient/surrogate decision-maker is informed about the risks and benefits of the proposed surgical procedure; secondary-stroke-prevention medications are reviewed; plans are made for interruptions and resumption; and intraoperative care is individualized to reduce the likelihood of postoperative stroke or death.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621668","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

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":null,"pages":null},"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

Pharmacokinetics in regional anesthesia. 区域麻醉的药代动力学。

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.0000000000001398

André M Leite-Moreira, André Correia, Nuno Vale, Joana B Mourão

{"title":"Pharmacokinetics in regional anesthesia.","authors":"André M Leite-Moreira, André Correia, Nuno Vale, Joana B Mourão","doi":"10.1097/ACO.0000000000001398","DOIUrl":"10.1097/ACO.0000000000001398","url":null,"abstract":"Purpose of review: Pharmacokinetics of local anesthetics are one of the main determinants of success and safety of regional anesthesia and comprise local and systemic distribution phases. This review aims to summarize the latest research findings on this topic in the context of various regional blocks performed for different surgeries and patient populations.Recent findings: Research into local kinetics and systemic absorption of local anesthetics has chiefly been focused on novel fascial plane blocks, especially the erector spinae plane block, as these are increasingly adopted for regional anesthesia and pain management. As their clinical efficacy is very dependent on injection of large volumes of local anesthetic, doses over typically recommended limits are often administered.Summary: Fascial plane blocks are the regional anesthesia techniques in need of the most pharmacokinetic characterization, not only to better understand their complex mechanisms of action but also to avoid harm from excessive doses of local anesthetics. Further mapping of risk factors for systemic toxicity from administration in different block sites is crucial. Extremes of age and pregnancy are vulnerable patient populations but in whom regional anesthesia, including novel techniques, has been performed with few complications.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621669","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

Current concepts and targets for preventing the transition of acute to chronic postsurgical pain. 预防手术后急性疼痛向慢性疼痛转变的当前概念和目标。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1097/ACO.0000000000001424

Adeeb Oweidat, Hari Kalagara, Rakesh V Sondekoppam

{"title":"Current concepts and targets for preventing the transition of acute to chronic postsurgical pain.","authors":"Adeeb Oweidat, Hari Kalagara, Rakesh V Sondekoppam","doi":"10.1097/ACO.0000000000001424","DOIUrl":"10.1097/ACO.0000000000001424","url":null,"abstract":"Purpose of review: It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact.Recent findings: From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain.Summary: A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861451","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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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