Current Opinion in Anesthesiology最新文献_第2页

Perioperative pain management for cardiac surgery. 心脏手术围术期疼痛管理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-10-28 DOI: 10.1097/ACO.0000000000001443

Masseh Yakubi, Sam Curtis, Sibtain Anwar

{"title":"Perioperative pain management for cardiac surgery.","authors":"Masseh Yakubi, Sam Curtis, Sibtain Anwar","doi":"10.1097/ACO.0000000000001443","DOIUrl":"10.1097/ACO.0000000000001443","url":null,"abstract":"Purpose of review: Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery.Recent findings: Current evidence and international guidelines support the use of multimodal analgesics for managing perioperative pain after cardiac surgery. Regional anaesthesia in the form of fascial plane blocks, such as the erector spinae plane and parasternal intercostal plane blocks, are effective and safe techniques for anticoagulated cardiac surgery patients. Transitional pain services are multidisciplinary programmes that bridge the gap between inpatient and outpatient care for these patients.Summary: This paper reviews advancements in perioperative pain management for cardiac surgery patients, emphasising the shift from high-dose opioids to multimodal analgesia and regional anaesthetic techniques, and highlighting the role of multidisciplinary transitional pain services.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"25-29"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632103","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

Perioperative management of patients with mediastinal mass syndrome. 纵隔肿块综合征患者的围手术期管理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-12-06 DOI: 10.1097/ACO.0000000000001453

Thomas Hachenberg, Thomas Schilling, Moritz Kretzschmar

{"title":"Perioperative management of patients with mediastinal mass syndrome.","authors":"Thomas Hachenberg, Thomas Schilling, Moritz Kretzschmar","doi":"10.1097/ACO.0000000000001453","DOIUrl":"10.1097/ACO.0000000000001453","url":null,"abstract":"Purpose of the review: The mediastinal mass syndrome (MMS) can occur after induction of anesthesia, intraoperatively or even days after the surgical procedure. The focus of this review is on the management of pediatric and adult patients with a significant mediastinal mass.Recent findings: The age distribution of patients with mediastinal lesions suggests a bimodal shape, with an increased incidence among children under 10 years old and adults aged 60-70 years old. The traditional approach to avoid general anesthesia and mechanical ventilation has been challenged recently. Induction of general anesthesia may be achieved by a titrated intravenous infusion of propofol, with the patient positioned in a semi-sitting position. Mechanical ventilation with a prolonged I:E ratio, low respiratory rate and rigid or flexible bronchoscopy to stent the obstructed airway can facilitate expiration of tidal volume. Continuous video bronchoscopy recordings of the compromised portion of the airway have shown that positive pressure ventilation and neuromuscular blockade can induce an increase in the mean airway patency score.Summary: Meticulous planning, implementation of anesthetic management protocols and protocols for emergency situations are essential to guarantee patient safety with a mediastinal mass.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"58-64"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820038","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

Safety amid the scalpels: creating psychological safety in the operating room. 手术刀下的安全：在手术室创造心理安全。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-04 DOI: 10.1097/ACO.0000000000001431

Jonathan B Cohen, Jennifer A Feldman-Brillembourg, Jason Cheng, Govind Rangrass

{"title":"Safety amid the scalpels: creating psychological safety in the operating room.","authors":"Jonathan B Cohen, Jennifer A Feldman-Brillembourg, Jason Cheng, Govind Rangrass","doi":"10.1097/ACO.0000000000001431","DOIUrl":"10.1097/ACO.0000000000001431","url":null,"abstract":"Purpose of review: We briefly review the concept of psychological safety and discuss the actions that can create it in the anesthesiologist's work environment.Recent findings: The interest in psychological safety has grown in popularity since the publication of Amy Edmondson's book The Fearless Organization in 2018. While the concept and its benefits are described in the healthcare literature, the specific actions necessary to create it are often not.Summary: To ensure patient safety, we want members of the teams we lead to be comfortable sharing emerging problems that they see before we become aware of them. As educators, we want trainees to approach us when they do not understand something and openly participate and contribute without the fear of how others will perceive them. These scenarios require an environment of psychological safety - the ability to ask for help, admit mistakes, and be respectfully forthright with unpopular beliefs without the fear of being ostracized or ignored. Methods for creating an environment of psychological safety will be discussed.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"669-675"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156495","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

Educating for success: ambulatory anesthesia training. 成功教育：非住院麻醉培训。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-08-22 DOI: 10.1097/ACO.0000000000001428

Nicholas R Cormier, Jaime B Hyman, Michael O'Rourke

{"title":"Educating for success: ambulatory anesthesia training.","authors":"Nicholas R Cormier, Jaime B Hyman, Michael O'Rourke","doi":"10.1097/ACO.0000000000001428","DOIUrl":"10.1097/ACO.0000000000001428","url":null,"abstract":"Purpose of review: This article explores the unique intersection of the challenges confronting ambulatory anesthesiology education and charts a trajectory forward. The proportion of ambulatory, nonoperating room (NORA), and office-based surgical cases continues to rise; however, the requirements for trainees in these settings have remained static. The rapid evolution of the field combined with a limited workforce also makes continuing education essential, and we discuss the current and future states of ambulatory anesthesia education.Recent findings: Although numerous resources are available across an array of platforms to foster both trainee education and continuing education for practicing anesthesiologists, there is a paucity of current literature evaluating the impact of new curricula developed specifically for ambulatory, NORA, or office-based anesthesiology (OBA).Summary: We begin with an appraisal of the current state of ambulatory anesthesiology training and evaluate the gap between current graduate medical education and trends in ambulatory surgery. We then develop a vision for an ideal state of future ambulatory education for residents as well as anesthesiologists in practice and highlight the priorities necessary to reach this vision.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"624-630"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156540","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

Critical patient safeguards for ambulatory surgery centers. 门诊手术中心的重要患者保障措施。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1097/ACO.0000000000001434

Jamey E Eklund, Candace C Chang, Melanie J Donnelly

{"title":"Critical patient safeguards for ambulatory surgery centers.","authors":"Jamey E Eklund, Candace C Chang, Melanie J Donnelly","doi":"10.1097/ACO.0000000000001434","DOIUrl":"10.1097/ACO.0000000000001434","url":null,"abstract":"Purpose of review: The role of ambulatory surgery centers in surgical care is evolving, as lower facility fees and improved patient experience increase the popularity of these venues. As care expands in ambulatory surgery center, so does the complexity of cases and patients cared for in these centers, which may pose a risk for patient safety. Anesthesiologists should lead multidisciplinary teams to screen for appropriate patients and procedures.Recent findings: Patient considerations go beyond physical status and include psychosocial factors. Ensuring patients understand preoperative instructions is crucial to decrease case cancellation rates and facilitate efficiency. Pediatric patients require special considerations including extra attention to preprocedure and postoperative care and instructions, PALS-certified staff, pediatric equipment and medications, as well as heightened awareness of respiratory complications.Summary: Procedural concerns start with the capabilities of the facility such as equipment, pharmacy, and staffing for each phase of care. However, nuances such as patient throughput in a given day, emergency preparedness, and after-hours staffing will affect both patient safety and staff morale. This article outlines the issues leaders need to consider to ensure patient safety in ambulatory surgery centers.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"719-726"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394943","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

Cardiovascular procedures in ambulatory cardiac procedures: really? 门诊心脏手术中的心血管程序：真的吗？

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-17 DOI: 10.1097/ACO.0000000000001435

Victor R Davila, Samiya Saklayen, Jonathan Tang

{"title":"Cardiovascular procedures in ambulatory cardiac procedures: really?","authors":"Victor R Davila, Samiya Saklayen, Jonathan Tang","doi":"10.1097/ACO.0000000000001435","DOIUrl":"10.1097/ACO.0000000000001435","url":null,"abstract":"Purpose of review: To evaluate the current trends, safety, and feasibility of same-day discharge (SDD) in ambulatory cardiac procedures, with a focus on percutaneous coronary interventions (PCI). This review also discusses the impact of technological advancements and explores future directions for expanding the scope of SDD in more complex cardiac procedures.Recent findings: Recent studies have demonstrated that SDD after PCI is both well tolerated and effective for appropriately selected patients, with outcomes comparable with those of patients who remain hospitalized overnight. Advancements in PCI technology, including improved stent designs, smaller sheath sizes, and the adoption of the transradial approach, have significantly enhanced the feasibility of SDD. Enhanced recovery after surgery (ERAS) pathways, adapted for ambulatory settings, further improve patient safety, particularly as more complex procedures are attempted. However, challenges remain in determining SDD eligibility, particularly in settings with limited emergency care capabilities.Summary: SDD is a viable and cost-effective option for low-risk patients undergoing PCI and other ambulatory cardiac procedures. The successful implementation of SDD requires careful patient selection, adherence to standardized protocols, and vigilant postprocedural monitoring. Future research should focus on refining patient selection tools, expanding the scope of SDD to include more complex procedures, and enhancing postdischarge monitoring through advanced technologies. Multidisciplinary collaboration and ongoing education are essential to support the well tolerated and effective adoption of SDD in ambulatory cardiac care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"638-643"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331712","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

Dental sedation permit requirements for physician anesthesiologists in the United States and the European Union: a review. 美国和欧盟对麻醉医师牙科镇静许可的要求：综述。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI: 10.1097/ACO.0000000000001442

Steve Yun, Nathanial Martin-Orr, Max Hendrix

{"title":"Dental sedation permit requirements for physician anesthesiologists in the United States and the European Union: a review.","authors":"Steve Yun, Nathanial Martin-Orr, Max Hendrix","doi":"10.1097/ACO.0000000000001442","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001442","url":null,"abstract":"Purpose of review: This review addresses the dental sedation permit requirements for physician anesthesiologists in the United States and the European Union (EU). The regulatory landscape for office-based anesthesia, including dental settings, is often described as the 'Wild West' of patient safety, making it crucial to outline the similarities and differences in dental anesthesia regulations and offer practical guidelines for regulators.Recent findings: There is virtually no literature that addresses the issue of dental sedation permits for physicians. By summarizing the variation in language and terminology from state to state, this review highlights the inconsistencies and gaps in dental regulations. The review also highlights the limited specific guidance on the permit process for physicians administering dental anesthesia.Summary: By comparing dental anesthesia regulations and guidelines across all U.S. states and the EU, the review aims to offer practical guidelines for regulators to institute an oversight process that is fair to physician anesthesiologists and does not impede their ability to practice in the dental office setting. This framework for credentialing and permitting physicians in dental office-based anesthesia settings is informed by existing safety recommendations and best practices.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"37 6","pages":"631-637"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548687","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

Best perioperative practices in the management of obstructive sleep apnea patients undergoing ambulatory surgery. 管理接受非住院手术的阻塞性睡眠呼吸暂停患者的最佳围手术期实践。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-11 DOI: 10.1097/ACO.0000000000001441

Ameya Pappu, Mandeep Singh

{"title":"Best perioperative practices in the management of obstructive sleep apnea patients undergoing ambulatory surgery.","authors":"Ameya Pappu, Mandeep Singh","doi":"10.1097/ACO.0000000000001441","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001441","url":null,"abstract":"Purpose of review: This review is timely due to the increasing prevalence of obstructive sleep apnea (OSA) among patients undergoing ambulatory surgery, necessitating updated perioperative management strategies to improve outcomes and reduce complications.Recent findings: Recent studies emphasize the importance of risk stratification using tools like STOP-Bang, highlighting the association between high-risk OSA and increased perioperative complications. Intraoperative management strategies, including the preference for regional anesthesia and careful monitoring of neuromuscular blockade, have been shown to mitigate risks. Postoperative protocols, particularly continuous monitoring, are crucial in preventing opioid-induced respiratory depression.Summary: Effective management of OSA in ambulatory surgery requires a multidisciplinary approach, encompassing preoperative screening, tailored intraoperative techniques, and vigilant postoperative monitoring. Implementing guidelines and protocols can significantly enhance patient safety and outcomes.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"37 6","pages":"644-650"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548685","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

Medication errors and mitigation strategies in obstetric anesthesia. 产科麻醉中的用药错误和缓解策略。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-20 DOI: 10.1097/ACO.0000000000001433

Emily E Sharpe, Lisa M Corbett, Mark D Rollins

{"title":"Medication errors and mitigation strategies in obstetric anesthesia.","authors":"Emily E Sharpe, Lisa M Corbett, Mark D Rollins","doi":"10.1097/ACO.0000000000001433","DOIUrl":"10.1097/ACO.0000000000001433","url":null,"abstract":"Purpose of review: Medication administration errors represent a significant yet preventable cause of patient harm in the peripartum period. Implementation of best practices contained in this manuscript can significantly reduce medication errors and associated patient harm.Recent findings: Cases of medication errors involving unintended intrathecal administration of tranexamic acid highlight the need to improve medication safety in peripartum patients and obstetric anesthesia.Summary: In obstetric anesthesia, medication errors can include wrong medication, dose, route, time, patient, or infusion setting. These errors are often underreported, have the potential to be catastrophic, and most can be prevented. Implementation of various types of best practice cost effective mitigation strategies include recommendations to improve drug labeling, optimize storage, determine correct medication prior to administration, use non-Luer epidural and intravenous connection ports, follow patient monitoring guidelines, use smart pumps and protocols for all infusions, disseminate medication safety educational material, and optimize staffing models. Vigilance in patient care and implementation of improved patient safety measures are urgently needed to decrease harm to mothers and newborns worldwide.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"736-742"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331713","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

Preventing perioperative infections: a call to action for anesthesiologists. 预防围手术期感染：麻醉医师的行动呼吁。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI: 10.1097/ACO.0000000000001432

Madina Gerasimov, Della M Lin, Uma Munnur, Melanie Donnelly

{"title":"Preventing perioperative infections: a call to action for anesthesiologists.","authors":"Madina Gerasimov, Della M Lin, Uma Munnur, Melanie Donnelly","doi":"10.1097/ACO.0000000000001432","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001432","url":null,"abstract":"Purpose of review: Surgical site infections (SSI) are one of the most costly complications and hospital organizations are promoting multidisciplinary approaches to address this harm. Anesthesiologists are increasingly recognized as key players influencing surgical outcomes and patient safety, and play a key role in preventing SSIs.Recent findings: Recent guidelines and strategies to prevent SSI are focused on the areas which anesthesiologists can impact including antimicrobial prophylaxis, proper hand hygiene, decontamination of environmental surfaces and operating room equipment coming in direct contact with patients.Summary: Timely interventions, including appropriate antibiotics' administration, practicing sterile and aseptic techniques when performing intraoperative procedures and handling medications are impactful steps in the process of improving rates of SSIs. Multidisciplinary participation in local and regional collaborative initiatives to improve adherence to best practices as well as integrated education of all the stakeholders are some of the principles of patient-centered care described in our review.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"37 6","pages":"712-718"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548690","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