Current Opinion in Anesthesiology最新文献_第6页

Preventing, identifying and managing myocardial injury after non cardiac surgery - a narrative review. 非心脏手术后心肌损伤的预防、识别和处理 - 综述。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-12-09 DOI: 10.1097/ACO.0000000000001454

Maria Wittmann, Tugce Dinc, Andrea Kunsorg, Maura Marcucci, Kurt Ruetzler

{"title":"Preventing, identifying and managing myocardial injury after non cardiac surgery - a narrative review.","authors":"Maria Wittmann, Tugce Dinc, Andrea Kunsorg, Maura Marcucci, Kurt Ruetzler","doi":"10.1097/ACO.0000000000001454","DOIUrl":"10.1097/ACO.0000000000001454","url":null,"abstract":"Purpose of review: There is mounting and convincing evidence that patients with postoperative troponin elevation, with or without any clinical symptoms, are at higher risk for both, short- and long-term morbidity and mortality. Myocardial injury after noncardiac surgery (MINS) is a relatively newly described syndrome, and the pathogenesis is not fully understood yet. MINS is now an established syndrome and multiple guidelines address potential etiologies, triggers, as well as preventive and management strategies.Recent findings: Surveillance in high-risk patients is required, as most MINS would otherwise be missed. There is no reliable and established preventive strategy, but several potentially avoidable triggers like hypotension, pain and anemia have been identified. Managing patients with MINS postoperatively includes minimizing triggers (such as hemodynamic abnormalities and anemia) that can continue the damage. Long-term pharmacologic strategies include beta-blockers, statins, antiplatelet agents, and anticoagulation.Summary: MINS affects up to 20% of surgical patients, remains clinically mostly silent, but is associated with elevated morbidity and mortality. A multidisciplinary approach, that includes involvement of anesthesiologists, for the prevention, diagnosis, and treatment of MINS is recommended.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"17-24"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820040","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 risk scores: prediction, pitfalls, and progress. 围手术期风险评分：预测、陷阱和进展。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-20 DOI: 10.1097/ACO.0000000000001445

Jonathan P Bedford, Oliver C Redfern, Benjamin O'Brien, Peter J Watkinson

{"title":"Perioperative risk scores: prediction, pitfalls, and progress.","authors":"Jonathan P Bedford, Oliver C Redfern, Benjamin O'Brien, Peter J Watkinson","doi":"10.1097/ACO.0000000000001445","DOIUrl":"10.1097/ACO.0000000000001445","url":null,"abstract":"Purpose of review: Perioperative risk scores aim to risk-stratify patients to guide their evaluation and management. Several scores are established in clinical practice, but often do not generalize well to new data and require ongoing updates to improve their reliability. Recent advances in machine learning have the potential to handle multidimensional data and associated interactions, however their clinical utility has yet to be consistently demonstrated. In this review, we introduce key model performance metrics, highlight pitfalls in model development, and examine current perioperative risk scores, their limitations, and future directions in risk modelling.Recent findings: Newer perioperative risk scores developed in larger cohorts appear to outperform older tools. Recent updates have further improved their performance. Machine learning techniques show promise in leveraging multidimensional data, but integrating these complex tools into clinical practice requires further validation, and a focus on implementation principles to ensure these tools are trusted and usable.Summary: All perioperative risk scores have some limitations, highlighting the need for robust model development and validation. Advancements in machine learning present promising opportunities to enhance this field, particularly through the integration of diverse data sources that may improve predictive performance. Future work should focus on improving model interpretability and incorporating continuous learning mechanisms to increase their clinical utility.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"30-36"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11676592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632106","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

Pro's and con's of different blocks for postoperative analgesia after video-assisted thoracic surgery. 胸腔镜手术后不同阻滞镇痛的利弊。

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.0000000000001451

M Ahmet Karakaya, Davud Yapici, Emre Sertac Bingül, Özlem Turhan, Mert Şentürk

引用次数: 0

Integrated psychosocial support in the ICU. ICU的综合社会心理支持。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2025-01-03 DOI: 10.1097/ACO.0000000000001455

Matthias Rose, Katrin Schürmann, Hannah Ferentzi, Katharina R L Schmitt

{"title":"Integrated psychosocial support in the ICU.","authors":"Matthias Rose, Katrin Schürmann, Hannah Ferentzi, Katharina R L Schmitt","doi":"10.1097/ACO.0000000000001455","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001455","url":null,"abstract":"Purpose of review: During treatment in the ICU, patients, relatives, as well as staff members are exposed to a variety of potentially traumatic experiences. The study explores current concepts to prevent negative effects on mental health resulting from intensive care treatment.Recent findings: Most healthcare systems rely on consultation or liaison services to address mental health issues provided by mental health experts based outside of the ICU. Those services usually react to manifest comorbid mental conditions, but are less effective to prevent mental health issues. Integrated psychosocial support (IPS) models acknowledge the fact that psychosocial demands are inherent to ICU treatment rather than an individual concern. First experiences support the assumption that clinical psychologists embedded within the ICU team effectively address the need of early identification of mental health issues, and are able to intervene timely and appropriately to traumatic events on the unit. They professionalize psychosocial support structures and facilitate low-threshold support for team members.Summary: Psychologists integrated in the ICU team can effectively target psychosocial needs of patients and relatives with varying complexity. They support the ICU team by taking on those tasks, and contribute to the overall resilience of the ICU team and its members.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"38 1","pages":"37-42"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922196","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

The climate crisis - actions to prioritize for anaesthesiologists. 气候危机--麻醉医师应优先采取的行动。

IF 2.3 3区医学

Current Opinion in Anesthesiology Pub Date : 2025-02-01 Epub Date: 2024-11-04 DOI: 10.1097/ACO.0000000000001444

Roberta Lawin-O'Brien, Elliot S Schwartz, Hugh Montgomery, Michael Nurok, Mark Coburn

{"title":"The climate crisis - actions to prioritize for anaesthesiologists.","authors":"Roberta Lawin-O'Brien, Elliot S Schwartz, Hugh Montgomery, Michael Nurok, Mark Coburn","doi":"10.1097/ACO.0000000000001444","DOIUrl":"10.1097/ACO.0000000000001444","url":null,"abstract":"Purpose of review: Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do.Recent findings: Encouraging continuing research regarding sustainable anaesthesia and expanding education at all levels to include climate action is key. Professionally, actions include limiting use of single-use equipment, reducing reliance on volatile gas inhalational anaesthesia, and adopting low fresh gas flow techniques. Personal actions such as climate-conscious travelling, spending, and eating are important, especially when shared to create climate positive movements.Summary: This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"9-16"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632067","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 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

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