Current Opinion in Anesthesiology最新文献_第4页

Caring for patients with diabetes in the outpatient surgical setting: current recommendations and controversies. 在门诊手术环境中照顾糖尿病患者：当前的建议和争议。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-09-19 DOI: 10.1097/ACO.0000000000001438

Elizabeth W Duggan, Guillermo E Umpierrez

{"title":"Caring for patients with diabetes in the outpatient surgical setting: current recommendations and controversies.","authors":"Elizabeth W Duggan, Guillermo E Umpierrez","doi":"10.1097/ACO.0000000000001438","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001438","url":null,"abstract":"Purpose of review: Perioperative outpatient (ambulatory) care of the adult patient with diabetes requires unique considerations that vary from the inpatient setting. This review highlights specific pre, intra, and postoperative care steps for patients with diabetes undergoing ambulatory surgery, summarizing recent clinical trials, expert reviews, and emerging evidence.Recent findings: There is a paucity of evidence examining optimal diabetes management in the outpatient setting. Currently, there are limited studies regarding preoperative management of oral hypoglycemic agents, home insulin, and carbohydrate-containing beverages.Summary: Future research needs to specifically examine chronic blood glucose control, day of surgery targets, effective home medication management and the risk of perioperative hyperglycemia in ambulatory surgery. Education, protocols and resources to support the care of perioperative patients in the outpatient setting will aid providers on the day of surgery and provide optimal diabetes care leading up to surgery.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"37 6","pages":"651-660"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548686","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

More than pacemakers and defibrillators: perioperative management of implantable devices for patient safety. 不仅仅是起搏器和除颤器：为患者安全而进行的植入式设备围手术期管理。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-12-01 Epub Date: 2024-08-19 DOI: 10.1097/ACO.0000000000001427

Monica W Harbell, Molly B Kraus, Andrea Lopez-Ruiz, Madina Gerasimov, Jillian A Maloney

{"title":"More than pacemakers and defibrillators: perioperative management of implantable devices for patient safety.","authors":"Monica W Harbell, Molly B Kraus, Andrea Lopez-Ruiz, Madina Gerasimov, Jillian A Maloney","doi":"10.1097/ACO.0000000000001427","DOIUrl":"10.1097/ACO.0000000000001427","url":null,"abstract":"Purpose of review: The use of implantable medical devices (IMDs) continues to increase with estimates that 10% of the American population will have an IMD in their lifetime. IMDs require special considerations for management in the perioperative period to ensure optimal patient care and patient safety. This review summarizes the current perioperative considerations for IMDs.Recent findings: This review summarizes perioperative recommendations for spinal cord stimulators, deep brain stimulators, peripheral nerve stimulators, vagus nerve stimulators, muscle stimulators, intrathecal drug delivery systems, implantable infusion pumps, artificial pancreas devices, continuous glucose monitors, and cochlear implants. There are multiple publications and guidelines regarding the perioperative considerations of cardiac implantable electronic devices; thus, this review excludes those devices. This review includes recommendations on management of the device perioperatively, the potential complications, and postoperative care of the device.Summary: There are very few guidelines regarding the perioperative management of IMDs. Given the significant impact that these devices have on patient care and safety, evidence-based guidelines should be established.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"705-711"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156494","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

An update on the perioperative management of postcraniotomy pain. 开颅术后疼痛围手术期处理的最新进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-08 DOI: 10.1097/ACO.0000000000001409

Cassandra Dean, Ian McCullough, Alex Papangelou

引用次数: 0

Spaceflight-associated pain. 太空飞行相关疼痛。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI: 10.1097/ACO.0000000000001401

Ariana M Nelson, Ryan A Lacinski, Jonathan G Steller

{"title":"Spaceflight-associated pain.","authors":"Ariana M Nelson, Ryan A Lacinski, Jonathan G Steller","doi":"10.1097/ACO.0000000000001401","DOIUrl":"10.1097/ACO.0000000000001401","url":null,"abstract":"Purpose of review: Consequences of the expanding commercial spaceflight industry include an increase in total number of spaceflight participants and an accompanying surge in the average number of medical comorbidities compared with government-based astronaut corps. A sequela of these developments is an anticipated rise in acute and chronic pain concerns associated with spaceflight. This review will summarize diagnostic and therapeutic areas of interest that can support the comfort of humans in spaceflight.Recent findings: Painful conditions that occur in space may be due to exposure to numerous stressors such as acceleration and vibration during launch, trauma associated with extravehicular activities, and morbidity resulting directly from weightlessness. Without normal gravitational forces and biomechanical stress, the hostile environment of space causes muscle atrophy, bone demineralization, joint stiffness, and spinal disc dysfunction, resulting in a myriad of pain generators. Repeated insults from abnormal environmental exposures are thought to contribute to the development of painful musculoskeletal and neuropathic conditions.Summary: As humanity invests in Lunar and Martian exploration, understanding the painful conditions that will impede crew productivity and mission outcomes is critical. Preexisting pain and new-onset acute or chronic pain resulting from spaceflight will require countermeasures and treatments to mitigate long-term health effects.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"581-587"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621670","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

Update on the anesthesia management in adult patients with moyamoya disease. moyamoya病成人患者麻醉管理的最新进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-28 DOI: 10.1097/ACO.0000000000001411

Kevin J Yang, Porus Mistry, Eugenia Ayrian

{"title":"Update on the anesthesia management in adult patients with moyamoya disease.","authors":"Kevin J Yang, Porus Mistry, Eugenia Ayrian","doi":"10.1097/ACO.0000000000001411","DOIUrl":"10.1097/ACO.0000000000001411","url":null,"abstract":"Purpose of review: The anesthetic management of patients with Moyamoya disease (MMD) is challenging and continues to evolve. The goal of this review is to provide updated recommendations on the anesthetic management of adult MMD patients based on the relevant existing literature.Recent findings: Key findings include the importance of aggressive hydration preoperatively to sustain cerebral perfusion. Hypertension induced intraoperatively may prevent cerebral hypoperfusion. Vigilance against cerebral hyperperfusion after revascularization is necessary, with specific blood pressure targets recommended. Fluid management should aim for normovolemia to mild hypervolemia. Maintaining body temperature helps prevent cerebral vasospasm induced by hypothermia. Maintaining adequate oxygen supply during surgery is crucial. In cases of ischemic stroke, managing hematocrit and oxygen carrying capacity is essential to prevent further ischemia. Extubation decisions should consider baseline neurological function, while postoperative normocapnia helps prevent cerebral hyperperfusion and hypertension. In intensive care, cautious blood pressure management is crucial to prevent secondary complications.Summary: Strategies in the preoperative, intraoperative, and postoperative anesthetic management of MMD patients should aim to maintain adequate cerebral perfusion to prevent cerebral ischemia.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"439-445"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621671","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

Kratom: a primer for pain physicians. 桔梗：疼痛科医生入门指南。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-08 DOI: 10.1097/ACO.0000000000001413

Trent Emerick, Shravani Durbhakula, Maria R Eibel, Lynn Kohan

{"title":"Kratom: a primer for pain physicians.","authors":"Trent Emerick, Shravani Durbhakula, Maria R Eibel, Lynn Kohan","doi":"10.1097/ACO.0000000000001413","DOIUrl":"10.1097/ACO.0000000000001413","url":null,"abstract":"Purpose of review: Kratom is used commonly in the United States, usually to mitigate pain, opioid withdrawal, or fatigue. A comprehensive discussion on kratom, tailored to pain management physicians, is needed, given its associated risks and potential interactions.Recent findings: Kratom and its main metabolites, mitragynine and 7-OH-mitragynine, bind to a variety of receptors including mu opioid receptors. Still, kratom cannot be described as a classic opioid. Kratom has been utilized without FDA approval as an alternative to traditional medications for opioid use disorder and opioid withdrawal. Lower doses of kratom typically cause opioid-like effects while higher doses can have sedating effects. Tolerance, dependence and withdrawal still occur, although kratom withdrawal appears to be more moderate than opioid withdrawal. Contamination with heavy metals and biological toxins is concerning and there is potential for serious complications, including seizures and death.Summary: The use of kratom as an opioid-sparing alternative as a part of a multimodal pain regimen is not without significant risks. It is of utmost importance for pain physicians to be aware of the risks and adverse effects associated with kratom use.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"575-580"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621663","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

Transitional pain services updates and a novel service for the obstetric population. 产科过渡性疼痛服务的更新和一项新服务。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-08-01 DOI: 10.1097/ACO.0000000000001417

Rafael Blanco, Tarek Ansari

引用次数: 0

Neuromodulation treatments for migraine: a contemporary update. 偏头痛的神经调节疗法：当代最新进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-07-08 DOI: 10.1097/ACO.0000000000001414

Jeffery Kramer, Salim Hayek, Robert Levy

{"title":"Neuromodulation treatments for migraine: a contemporary update.","authors":"Jeffery Kramer, Salim Hayek, Robert Levy","doi":"10.1097/ACO.0000000000001414","DOIUrl":"10.1097/ACO.0000000000001414","url":null,"abstract":"Purpose of review: Neuromodulation approaches have been a part of a revolution in migraine therapies with multiple devices approved or in development. These devices vary in the nerve(s) being targeted, implantable versus noninvasive form factors as well as their effectiveness for acute pain reduction or migraine prevention. This review will summarize these recent advancements and approaches that are being developed which build upon prior work and improved technology that may help enhance the effectiveness as well as the patient experience.Recent findings: Both noninvasive and implantable devices primarily targeting cranial nerves have shown the ability to help alleviate migraine symptoms. Multiple prospective and retrospective studies have demonstrated clinically meaningful reductions in headache intensity with noninvasive approaches, while prevention of migraine demonstrates more modest effects. Implantable neuromodulation technologies focusing on occipital and supraorbital stimulation have shown promise in migraine/headache prevention in chronic migraine patients, but there is a need for improvements in technology to address key needs for surgical approaches.Summary: Electrical neuromodulation approaches in the treatment of migraine is undergoing a transformation towards improved outcomes with better technologies that may suit various patient needs on a more individualized basis.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"597-603"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621666","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

Harnessing artificial intelligence for predicting and managing postoperative pain: a narrative literature review. 利用人工智能预测和管理术后疼痛：文献综述。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1097/ACO.0000000000001408

Ruba Sajdeya, Samer Narouze

{"title":"Harnessing artificial intelligence for predicting and managing postoperative pain: a narrative literature review.","authors":"Ruba Sajdeya, Samer Narouze","doi":"10.1097/ACO.0000000000001408","DOIUrl":"10.1097/ACO.0000000000001408","url":null,"abstract":"Purpose of review: This review examines recent research on artificial intelligence focusing on machine learning (ML) models for predicting postoperative pain outcomes. We also identify technical, ethical, and practical hurdles that demand continued investigation and research.Recent findings: Current ML models leverage diverse datasets, algorithmic techniques, and validation methods to identify predictive biomarkers, risk factors, and phenotypic signatures associated with increased acute and chronic postoperative pain and persistent opioid use. ML models demonstrate satisfactory performance to predict pain outcomes and their prognostic trajectories, identify modifiable risk factors and at-risk patients who benefit from targeted pain management strategies, and show promise in pain prevention applications. However, further evidence is needed to evaluate the reliability, generalizability, effectiveness, and safety of ML-driven approaches before their integration into perioperative pain management practices.Summary: Artificial intelligence (AI) has the potential to enhance perioperative pain management by providing more accurate predictive models and personalized interventions. By leveraging ML algorithms, clinicians can better identify at-risk patients and tailor treatment strategies accordingly. However, successful implementation needs to address challenges in data quality, algorithmic complexity, and ethical and practical considerations. Future research should focus on validating AI-driven interventions in clinical practice and fostering interdisciplinary collaboration to advance perioperative care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"604-615"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621661","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

Lumbar transforaminal epidural steroid injections with particulate vs. nonparticulate steroid: an evidence-informed review on shifting gear to a personalized medicine paradigm. 腰椎经椎间孔硬膜外类固醇注射与微粒类固醇注射：转向个性化医疗模式的循证综述。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI: 10.1097/ACO.0000000000001402

Steven P Cohen, Jason D Ross

{"title":"Lumbar transforaminal epidural steroid injections with particulate vs. nonparticulate steroid: an evidence-informed review on shifting gear to a personalized medicine paradigm.","authors":"Steven P Cohen, Jason D Ross","doi":"10.1097/ACO.0000000000001402","DOIUrl":"10.1097/ACO.0000000000001402","url":null,"abstract":"Purpose of review: To provide an evidence-informed review weighing the pros and cons of particulate vs. nonparticulate steroids for lumbar transforaminal epidural steroid injections (TFESI).Recent findings: The relative use of nonparticulate vs. particulate steroids for lumbar TFESI has risen recently in light of catastrophic consequences reported for the latter during cervical TFESI. Among various causes of spinal cord infarct, an exceedingly rare event in the lower lumbar spine, embolization of particulate steroid is among the least likely. Case reports have documented cases of spinal cord infarct during lower lumbar TFESI with both particulate and nonparticulate steroids, with database reviews finding no difference in complication rates. There is some evidence for superiority of particulate over nonparticulate steroids in well-designed studies, which could lead to increase steroid exposure (i.e. more injections) and treatment failure resulting in surgical and/or opioid management when nonparticulate steroids are utilized.Summary: Similar to a paradigm shift in medicine, a personalized approach based on a shared decision model and the consequences of treatment failure, should be utilized in deciding which steroid to utilize. Alternatives to ESI include high-volume injections with nonsteroid solutions, and the use of hypertonic saline, which possesses anti-inflammatory properties and has been shown to be superior to isotonic saline in preliminary clinical studies.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"565-574"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621664","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