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Current Opinion in Anesthesiology最新文献

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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":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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).</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"446-452"},"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":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"504-512"},"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
{"title":"Neurologic disease in the obstetric patient.","authors":"Konstantin Inozemtsev, Evelyn Yeh, Ned F Nasr","doi":"10.1097/ACO.0000000000001405","DOIUrl":"10.1097/ACO.0000000000001405","url":null,"abstract":"<p><strong>Purpose of review: </strong>Neurologic disorders and complications during pregnancy are common, but guidelines and data are sparse. This review aims to give an overview of recent developments in neuroanesthesia and management of neuropathology during pregnancy, with the hope that these may fill the gaps in current guidelines and recommendations, as well as their implications for an anesthetic approach.</p><p><strong>Recent findings: </strong>Neuraxial and general anesthesia are safe in multiple sclerosis and myasthenia gravis, though neuromuscular blockade response is unpredictable and risk for exacerbation exists. Cerebral vascular pathology is common and carries a significant morbidity and mortality burden, but thrombolytic and endovascular therapies are often appropriate and safe. Instrumental vaginal delivery can minimize intracranial pressure shifts and is a viable option. Tumors and cerebral malformations require a complex multidisciplinary and anesthetic approach.</p><p><strong>Summary: </strong>While clinical trials remain sparse, larger population-based studies offer insight into the optimal approach to the parturient with neurologic disease.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"453-459"},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621665","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
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":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"541-546"},"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":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"526-532"},"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
Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia. 重症监护创新：重症监护中的镇痛导航：区域麻醉的作用。
IF 2.5 3区 医学
Current Opinion in Anesthesiology Pub Date : 2024-08-08 DOI: 10.1097/aco.0000000000001422
Amber Campbell,Mackenzie Jacoby,Nadia Hernandez
{"title":"Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia.","authors":"Amber Campbell,Mackenzie Jacoby,Nadia Hernandez","doi":"10.1097/aco.0000000000001422","DOIUrl":"https://doi.org/10.1097/aco.0000000000001422","url":null,"abstract":"PURPOSE OF REVIEWThe purpose of this article is to provide an update of regional anesthesia and its applications in the critical care patient population.RECENT FINDINGSRegional anesthesia including blocks of the abdomen and thorax, head and neck, as well as upper and lower extremities can be used to alleviate pain and assist in managing life-threatening conditions such as cerebral vasospasm and ventricular storm in the ICU population. There have been many advances in these techniques including ultrasound-guidance with innovative approaches that allow for more superficial procedures that are safer for critically ill patients. Regional anesthesia can decrease hospital length of stay (LOS), prevent ICU admission, shorten ICU LOS, and increase ventilator free days and may have mortality benefits.SUMMARYPain management in the ICU is an important and sometimes challenging aspect of patient care. Regional anesthetic techniques have more indications and are safe, versatile tools that should be incorporated into care of critically ill patients.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"11 1","pages":"547-552"},"PeriodicalIF":2.5,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181232","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
Why sedative hypnotics often fail in development. 镇静催眠药为何常常研发失败？
IF 2.3 3区 医学
Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-03 DOI: 10.1097/ACO.0000000000001381
J Robert Sneyd
{"title":"Why sedative hypnotics often fail in development.","authors":"J Robert Sneyd","doi":"10.1097/ACO.0000000000001381","DOIUrl":"10.1097/ACO.0000000000001381","url":null,"abstract":"<p><strong>Purpose of review: </strong>Drug development to support anaesthesia and sedation has been slow with few candidates emerging from preclinical discovery and limited innovation beyond attempted reformulation of existing compounds.</p><p><strong>Recent findings: </strong>The market is well supported by low-cost generic products and development compounds have not been shown to improve patient outcomes or possess other distinctive characteristics to justify the cost of development.</p><p><strong>Summary: </strong>To make progress in a large-volume, low margin and highly competitive environment requires meaningful advances in relevant basic science. Opportunities exist, but probably require bolder initiatives than further attempts at reformulation or fiddling with the structure of propofol. Extending development ambitions to include nonanaesthesiologist providers challenges professional boundaries but may facilitate cost-effective changes in patterns of care.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"391-397"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260387","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
Artificial intelligence and nonoperating room anesthesia. 人工智能与非手术室麻醉。
IF 2.3 3区 医学
Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-16 DOI: 10.1097/ACO.0000000000001388
Emmanuel Pardo, Elena Le Cam, Franck Verdonk
{"title":"Artificial intelligence and nonoperating room anesthesia.","authors":"Emmanuel Pardo, Elena Le Cam, Franck Verdonk","doi":"10.1097/ACO.0000000000001388","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001388","url":null,"abstract":"<p><strong>Purpose of review: </strong>The integration of artificial intelligence (AI) in nonoperating room anesthesia (NORA) represents a timely and significant advancement. As the demand for NORA services expands, the application of AI is poised to improve patient selection, perioperative care, and anesthesia delivery. This review examines AI's growing impact on NORA and how it can optimize our clinical practice in the near future.</p><p><strong>Recent findings: </strong>AI has already improved various aspects of anesthesia, including preoperative assessment, intraoperative management, and postoperative care. Studies highlight AI's role in patient risk stratification, real-time decision support, and predictive modeling for patient outcomes. Notably, AI applications can be used to target patients at risk of complications, alert clinicians to the upcoming occurrence of an intraoperative adverse event such as hypotension or hypoxemia, or predict their tolerance of anesthesia after the procedure. Despite these advances, challenges persist, including ethical considerations, algorithmic bias, data security, and the need for transparent decision-making processes within AI systems.</p><p><strong>Summary: </strong>The findings underscore the substantial benefits of AI in NORA, which include improved safety, efficiency, and personalized care. AI's predictive capabilities in assessing hypoxemia risk and other perioperative events, have demonstrated potential to exceed human prognostic accuracy. The implications of these findings advocate for a careful yet progressive adoption of AI in clinical practice, encouraging the development of robust ethical guidelines, continual professional training, and comprehensive data management strategies. Furthermore, AI's role in anesthesia underscores the need for multidisciplinary research to address the limitations and fully leverage AI's capabilities for patient-centered anesthesia care.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":"37 4","pages":"413-420"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460574","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 drug titration paradox: a control engineering perspective. 药物滴定悖论：控制工程的视角。
IF 2.3 3区 医学
Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI: 10.1097/ACO.0000000000001396
Elie Sarraf
{"title":"The drug titration paradox: a control engineering perspective.","authors":"Elie Sarraf","doi":"10.1097/ACO.0000000000001396","DOIUrl":"10.1097/ACO.0000000000001396","url":null,"abstract":"<p><strong>Purpose of review: </strong>The drug titration paradox describes that, from a population standpoint, drug doses appear to have a negative correlation with its clinical effect. This paradox is a relatively modern discovery in anesthetic pharmacology derived from large clinical data sets. This review will interpret the paradox using a control engineering perspective.</p><p><strong>Recent findings: </strong>Drug titration is a challenging endeavor, and the medication delivery systems used in everyday clinical practice, including infusion pumps and vaporizers, typically do not allow for rapid or robust titration of medication being delivered. In addition, clinicians may be reluctant to deviate from a predetermined plan or may be content to manage patients within fixed goal boundaries.</p><p><strong>Summary: </strong>This drug titration paradox describes the constraints of how the average clinician will dose a patient with an unknown clinical response. While our understanding of the paradox is still in its infancy, it remains unclear how alternative dosing schemes, such as through automation, may exceed the boundaries of the paradox and potentially affect its conclusions.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"362-370"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260344","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
Remifentanil-induced hyperalgesia: the current state of affairs. 瑞芬太尼诱发的痛觉减退：现状。
IF 2.3 3区 医学
Current Opinion in Anesthesiology Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI: 10.1097/ACO.0000000000001400
Alexander A Vitin, Talmage D Egan
{"title":"Remifentanil-induced hyperalgesia: the current state of affairs.","authors":"Alexander A Vitin, Talmage D Egan","doi":"10.1097/ACO.0000000000001400","DOIUrl":"10.1097/ACO.0000000000001400","url":null,"abstract":"<p><p>Remifentanil-induced hyperalgesia (RIH) is a part of a general opioid-induced hyperalgesia (OIH) syndrome, seemingly resulting from abrupt cessation of continuous remifentanil infusion at rates equal or exceeding 0.3 mcg/kg/min. The intricate mechanisms of its development are still not completely understood. However, hyperactivation of the N -methyl d -aspartate receptor system, descending spinal facilitation and increased concentration of dynorphin (a κ-opioid ligand) are commonly proposed as possible mechanisms. Several ways of prevention and management have been suggested, such as slow withdrawal of remifentanil infusion, the addition of propofol, pretreatment with or concomitant administration of ketamine, buprenorphine, cyclooxygenase-2 inhibitors (NSAIDs), methadone, dexmedetomidine. In clinical and animal studies, these strategies exhibited varying success, and many are still being investigated.</p>","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":" ","pages":"371-378"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263512","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
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