Current Opinion in Anesthesiology最新文献_第3页

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 : 2025-03-14 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. 癌症治疗中的麻醉考虑。

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

Updates in Non-Operating Room Anesthesia. 非手术室麻醉的最新进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-03-05 DOI: 10.1097/ACO.0000000000001472

Aaron Primm, Diana Anca

{"title":"Updates in Non-Operating Room Anesthesia.","authors":"Aaron Primm, Diana Anca","doi":"10.1097/ACO.0000000000001472","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001472","url":null,"abstract":"Purpose of review: With an increase in the number and complexity of procedures in nonoperating room anesthesia (NORA) locations, navigating the landscape of planning, scheduling, workflow, and patient and clinician safety adds to the challenges of NORA space, requiring coordination of multiple teams and regulatory platforms.Recent findings: With the constant increase in cases performed in the NORA space, expected to reach 50% of all anesthetics in the next decade, significant strides must be made in assuring patients' and clinicians' safety. New procedures have been developed and approved in all procedural areas, and anesthesiologists are leading the charge in getting all stakeholders together. Anesthesia departments face increased demand for those services, so establishing a NORA leadership to collaborate and coordinate the efforts is very important.Summary: The review summarizes new developments in different procedural areas and their anesthetic management, and new recommendations by the American Society of Anesthesiology and Anesthesia Patient Safety Foundation for the safe conduct of anesthesia in the NORA space.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607127","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

Fluid management in hemorrhagic shock. 失血性休克的液体处理

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-03-05 DOI: 10.1097/ACO.0000000000001481

Andreas Markl-Le-Lev E, Ingrid Haller, Mirjam Bachler

{"title":"Fluid management in hemorrhagic shock.","authors":"Andreas Markl-Le-Lev E, Ingrid Haller, Mirjam Bachler","doi":"10.1097/ACO.0000000000001481","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001481","url":null,"abstract":"Purpose of review: Fluid management in hemorrhagic shock is a controversial topic, and there are evolving clinical guidelines and evidence-based practice. This review aims to highlight the physiological aspects in the light of current evidence on which volume replacement solution to use.Recent findings: Current evidence and international guidelines are shifting from a liberal to a restrictive fluid resuscitation strategy, emphasizing the potential risks associated with aggressive fluid therapy. The 'lethal triad of trauma' (hypoperfusion, acidosis, and coagulopathy) plays a crucial role in the pathophysiology of hemorrhagic shock. While crystalloids are less effective at restoring intravascular volume, colloids (especially hydroxyethyl starch) have raised concerns about potential adverse effects on renal function and coagulation. Albumin remains controversial, as studies showing no clear benefit and an increased mortality in traumatic brain injury patients. Fresh frozen plasma, may be useful in massive transfusion situations but is not recommended for volume resuscitation.Summary: The management of fluid resuscitation evolves, with a trend toward more restrictive strategies. Crystalloids, although less effective for severe volume depletion, remain a cornerstone of initial resuscitation. Among the colloids, gelatin-based solutions and albumin can be used when crystalloids are inadequate, while hydroxyethyl starch is no longer recommended.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607124","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

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 : 2025-02-28 DOI: 10.1097/ACO.0000000000001480

Shahla Siddiqui

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 : 2025-02-28 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":"https://doi.org/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":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-28","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

Bleeding management in pelvic trauma: state of the art. 骨盆创伤出血处理：最新进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-28 DOI: 10.1097/ACO.0000000000001478

Paul Puchwein, Barbara Hallmann, Nicolas Eibinger

{"title":"Bleeding management in pelvic trauma: state of the art.","authors":"Paul Puchwein, Barbara Hallmann, Nicolas Eibinger","doi":"10.1097/ACO.0000000000001478","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001478","url":null,"abstract":"Purpose of review: Bleeding complications from pelvic injuries occur after high-energy trauma as well as after low-energy trauma in elderly patients and are the main contributors to mortality. Demographic changes necessitate focussing on both entities and targeted therapies throughout the course of management.Recent findings: This article reviews the recent evidence and expertise on bleeding management for haemodynamically unstable patients with pelvic fractures with insights from prehospital care to trends in resuscitation and endovascular techniques and revival of older strategies, to challenges of definitive treatment. It also takes a closer look into pelvic fractures of the elderly and their most recent treatment options.Summary: Bleeding management in pelvic trauma begins prehospitally with targeted transportation, infusion of crystalloids and blood products, and a differentiated use of pelvic binders. In the emergency department, care involves rapid evaluation, massive transfusion protocols and computed tomography (CT) angiography. Resuscitative Endovascular Balloon Occlusion of the Aorta can serve as bridging to diagnostics and bleeding control. Bleeding control management includes mechanical stabilization, preperitoneal pelvic packing or angioembolization. In elderly patients, rigid vessels and anticoagulation contribute to bleeding complications. Selective CT angiography is advised for certain injury patterns and haemodynamic instability. Depending on bleeding localization, selective angioembolization is preferred.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607114","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 management of neurosurgical emergencies. 神经外科急诊的麻醉处理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-17 DOI: 10.1097/ACO.0000000000001471

Vanessa Bou Sleiman, Bryan Benson, Sam Gumbert

{"title":"Anesthetic management of neurosurgical emergencies.","authors":"Vanessa Bou Sleiman, Bryan Benson, Sam Gumbert","doi":"10.1097/ACO.0000000000001471","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001471","url":null,"abstract":"Purpose of review: Neuroanesthesia presents unique challenges that require up-to-date knowledge in identification and management and multidisciplinary collaboration for optimal patient outcomes. This review paper aims to enhance the reader's understanding and preparedness for intraoperative emergencies based on current literature updates and consensus recommendations.Recent findings: Recent findings in traumatic brain injury (TBI) emphasize the importance of controlling intracranial pressure (ICP) and maintaining cerebral perfusion. However, they also challenge the efficacy of sole ICP targeting interventions, suggesting potential benefits from multimodal monitoring approaches. In the context of acute stroke, recent randomized trials have demonstrated that general anesthesia (GA) compared with sedation techniques results in higher recanalization rates, with no significant difference in complications or long-term outcomes. Furthermore, multiple trials and a meta-analysis have shown that intensive blood pressure management following recanalization with endovascular therapy (EVT) offers no benefit and may impose harm when compared with conservative blood pressure targets.Summary: Optimal management of neuroanesthetic emergencies requires up-to-date knowledge, training, and interdisciplinary coordination to ensure the best possible outcomes. Significant research effort has been devoted to advancing neuroanesthesia practice, so that in the last 2 years, several fundamental management questions have benefitted from randomized controlled trials (RCTs) from multiple groups, as well as meta-analyses of these RCTs. These address ICP and complementary physiologic monitoring for intracranial compartment syndrome after TBI, GA versus sedation for EVT, and postrecanalization blood pressure management. In this review, we have highlighted this important work as well as the next steps in further refining answers to these questions.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607111","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 opinion in anesthesiology: post-traumatic stress disorder following birth. 当前麻醉学观点：产后创伤后应激障碍。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-17 DOI: 10.1097/ACO.0000000000001470

Lindsay Shea Tremper, Kaitlyn Elizabeth Neumann

{"title":"Current opinion in anesthesiology: post-traumatic stress disorder following birth.","authors":"Lindsay Shea Tremper, Kaitlyn Elizabeth Neumann","doi":"10.1097/ACO.0000000000001470","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001470","url":null,"abstract":"Purpose of review: Traumatic childbirth can lead to childbirth-related post-traumatic stress disorder (CB-PTSD) or retraumatize those with prior trauma, contributing to long-term maternal and neonatal morbidity and mortality. This condition affects approximately 4-7% of postpartum patients. Given the concerningly high maternal morbidity and mortality rates in the USA, it is crucial to further analyze the risk factors and clinical management recommendations for the prevention of CB-PTSD.Recent findings: Research highlights the negative outcomes and high costs associated with CB-PTSD. Studies have found that preexisting mental health conditions, patient perception of delivery, and certain obstetric and anesthetic complications may significantly impact CB-PTSD development.Additionally, screening tools are available, with some proven effective in this population.Summary: Recent literature underscores the anesthesiologist's role in preventing and detecting CB-PTSD. Although there is a lack of standardized screening practices for CB-PTSD, awareness of this disorder is on the rise. By adopting a trauma-informed care model including anesthesia consultation, providing effective analgesia and anesthesia, maintaining a clinical practice that minimizes anesthetic complications, and identifying patients who perceive their experience as traumatic, anesthesiologists can help mitigate the prevalence of CB-PTSD, and thus its associated maternal morbidity and mortality.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607118","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 opinion: an overview of sickle cell disease and chronic pain and perioperative considerations. 当前观点：镰状细胞病和慢性疼痛的综述及围手术期注意事项。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-14 DOI: 10.1097/ACO.0000000000001461

Dolapo Akintunde, Ada Ezihe-Ejiofor, Janefrances Ogbah, Tolulope Oso

{"title":"Current opinion: an overview of sickle cell disease and chronic pain and perioperative considerations.","authors":"Dolapo Akintunde, Ada Ezihe-Ejiofor, Janefrances Ogbah, Tolulope Oso","doi":"10.1097/ACO.0000000000001461","DOIUrl":"10.1097/ACO.0000000000001461","url":null,"abstract":"Purpose: This review aims to provide the practicing anesthesiologist with information on the pathophysiology, physiology, and management of patients with sickle cell disease. This includes the evaluation of common intraoperative management issues as well as perioperative concerns related to the disease. This review will also discuss the outpatient care of sickle cell patients concerning disease-modifying agents and chronic pain management.Recent findings: There has been less funding for research on sickle cell disease and a relative deficit in treatment options for patients and their vaso-occlusive crises (VOC). In the chronic pain setting, adjuvants to therapy have been utilized, such as anti-inflammatories, neuropathic agents, and antihistamines; however, the mainstay of therapy for pain crises is the use of opioids. New medications for the treatment of VOCs include crinaluzimab and L-glutamine. In terms of intraoperative management, it is imperative to maintain homeostasis for the patients, and research does not show a benefit in preoperative blood transfusions when not clinically indicated.Summary: The sociopolitical context and pathophysiology of sickle cell disease make it a unique disease to manage for the practicing anesthesiologist. Tailoring management via developing a patient-specific approach to maintain homeostasis and minimize the perioperative prevalence of VOCs.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411372","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