Current Opinion in Anesthesiology最新文献_第9页

Intraoperative EEG-based monitors: are we looking under the lamppost? 基于脑电图的术中监护仪：我们是否正在灯柱下寻找？

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-10 DOI: 10.1097/ACO.0000000000001339

Dana Baron Shahaf, Goded Shahaf

{"title":"Intraoperative EEG-based monitors: are we looking under the lamppost?","authors":"Dana Baron Shahaf, Goded Shahaf","doi":"10.1097/ACO.0000000000001339","DOIUrl":"10.1097/ACO.0000000000001339","url":null,"abstract":"Purpose of review: While electroencephalogram (EEG)-based depth of anesthesia monitors have been in use clinically for decades, there is still a major debate concerning their efficacy for detecting awareness under anesthesia (AUA). Further utilization of these monitors has also been discussed vividly, for example, reduction of postoperative delirium (POD).It seems that with regard to reducing AUA and POD, these monitors might be applicable, under specific anesthetic protocols. But in other settings, such monitoring might be less contributive and may have a 'built-it glass ceiling'.Recent advances in other venues of electrophysiological monitoring might have a strong theoretical rationale, and early supporting results, to offer a breakthrough out of this metaphorical glass ceiling. The purpose of this review is to present this possibility.Recent findings: Following previous findings, it might be concluded that for some anesthesia protocols, the prevailing depth of anesthesia monitors may prevent incidences of AUA and POD. However, in other settings, which may involve other anesthesia protocols, or specifically for POD - other perioperative causes, they may not. Attention-related processes measured by easy-to-use real-time electrophysiological markers are becoming feasible, also under anesthesia, and might be applicable for more comprehensive prevention of AUA, POD and possibly other perioperative complications.Summary: Attention-related monitoring might have a strong theoretical basis for the prevention of AUA, POD, and potentially other distressing postoperative outcomes, such as stroke and postoperative neurocognitive disorder. There seems to be already some initial supporting evidence in this regard.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934008","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

Acute kidney injury after cardiac surgery. 心脏手术后急性肾损伤。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-10-05 DOI: 10.1097/ACO.0000000000001320

Thilo von Groote, Mahan Sadjadi, Alexander Zarbock

引用次数: 0

Perioperative hemodynamic monitoring in cardiac surgery. 心脏手术围术期血液动力学监测。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-20 DOI: 10.1097/ACO.0000000000001327

Michael C Grant, Rawn Salenger, Kevin W Lobdell

{"title":"Perioperative hemodynamic monitoring in cardiac surgery.","authors":"Michael C Grant, Rawn Salenger, Kevin W Lobdell","doi":"10.1097/ACO.0000000000001327","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001327","url":null,"abstract":"Purpose of review: Cardiac surgery has traditionally relied upon invasive hemodynamic monitoring, including regular use of pulmonary artery catheters. More recently, there has been advancement in our understanding as well as broader adoption of less invasive alternatives. This review serves as an outline of the key perioperative hemodynamic monitoring options for cardiac surgery.Recent findings: Recent study has revealed that the use of invasive monitoring such as pulmonary artery catheters or transesophageal echocardiography in low-risk patients undergoing low-risk cardiac surgery is of questionable benefit. Lesser invasive approaches such a pulse contour analysis or ultrasound may provide a useful alternative to assess patient hemodynamics and guide resuscitation therapy. A number of recent studies have been published to support broader indication for these evolving technologies.Summary: More selective use of indwelling catheters for cardiac surgery has coincided with greater application of less invasive alternatives. Understanding the advantages and limitations of each tool allows the bedside clinician to identify which hemodynamic monitoring modality is most suitable for which patient.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812972","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

Editorial introductions. 编辑介绍。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-12-21 DOI: 10.1097/ACO.0000000000001331

引用次数: 0

Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery. 获得视频辅助胸腔镜手术疼痛管理的 7 点金牌。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-09 DOI: 10.1097/ACO.0000000000001325

Danny Feike Hoogma, Liesbeth Brullot, Steve Coppens

{"title":"Get your 7-point golden medal for pain management in video-assisted thoracoscopic surgery.","authors":"Danny Feike Hoogma, Liesbeth Brullot, Steve Coppens","doi":"10.1097/ACO.0000000000001325","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001325","url":null,"abstract":"Purpose of review: Thoracic surgery is evolving, necessitating an adaptation for perioperative anesthesia and analgesia. This review highlights the recent advancements in perioperative (multimodal) analgesia for minimally invasive thoracic surgery.Recent findings: Continuous advancements in surgical techniques have led to a reduction in surgical trauma. However, managing perioperative pain remains a major challenge, impeding postoperative recovery. The traditional neuraxial technique is now deemed outdated for minimally invasive thoracic surgery. Instead, newer regional techniques have emerged, and traditional approaches have undergone (re-)evaluation by experts and professional societies to establish guidelines and practices. Assessing the quality of recovery, evenafter discharge, has become a crucial factor in evaluating the effectiveness of these strategies, aiding clinicians in making informed decisions to improve perioperative care.Summary: In the realm of minimally invasive thoracic surgery, perioperative analgesia is typically administered through systemic and regional techniques. Nevertheless, collaboration between anesthesiologists and surgeons, utilizing surgically placed nerve blocks and an active chest drain management, has the potential to significantly improve overall patient care.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812965","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 guidelines and recommendations for enhanced recovery after thoracic surgery. 胸外科手术后加强恢复的最新指南和建议。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-11-23 DOI: 10.1097/ACO.0000000000001328

Joshua B Cohen, Bradford B Smith, Emily G Teeter

{"title":"Update on guidelines and recommendations for enhanced recovery after thoracic surgery.","authors":"Joshua B Cohen, Bradford B Smith, Emily G Teeter","doi":"10.1097/ACO.0000000000001328","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001328","url":null,"abstract":"Purpose of review: Enhanced recovery after thoracic surgery (ERATS) has continued its growth in popularity over the past few years, and evidence for its utility is catching up to other specialties. This review will present and examine some of that accumulated evidence since guidelines sponsored by the Enhanced Recovery after Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) were first published in 2019.Recent findings: The ERAS/ESTS guidelines published in 2019 have not been updated, but new studies have been done and new data has been published regarding some of the individual components of the guidelines as they relate to thoracic and lung resection surgery. While there is still not a consensus on many of these issues, the volume of available evidence is becoming more robust, some of which will be incorporated into this review.Summary: The continued accumulation of data and evidence for the benefits of enhanced recovery techniques in thoracic and lung resection surgery will provide the thoracic anesthesiologist with guidance on how to best care for these patients before, during, and after surgery. The data from these studies will also help to elucidate which components of ERAS protocols are the most beneficial, and which components perhaps do not provide as much benefit as previously thought.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812976","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

Emerging principles and practices in enhanced recovery after thoracic surgery. 加强胸外科手术后恢复的新原则和实践。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-12-21 DOI: 10.1097/ACO.0000000000001329

Tjorvi E Perry

引用次数: 0

Nutrition support for patients on mechanical circulatory support. 为机械循环支持患者提供营养支持。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-10-06 DOI: 10.1097/ACO.0000000000001323

Ellen Dresen, Ranna Modir, Christian Stoppe

{"title":"Nutrition support for patients on mechanical circulatory support.","authors":"Ellen Dresen, Ranna Modir, Christian Stoppe","doi":"10.1097/ACO.0000000000001323","DOIUrl":"10.1097/ACO.0000000000001323","url":null,"abstract":"Purpose of review: No specific guidelines on medical nutrition therapy (MNT) in patients on different types of mechanical circulatory support (MCS) devices yet exist and overall evidence is limited. The purpose of this narrative review is to provide an overview about current existing evidence, which might be of underrecognized importance for the patients' short-term and long-term clinical and functional outcomes.Recent findings: Patients on MCS inherit substantial metabolic, endocrinologic, inflammatory, and immunologic alterations, and together with the specificities of MCS therapy, technical modalities of respective devices, and concomitant medication, the consideration of individualized MNT approaches is indicated in routine clinical practice. Exemplarily, the evaluation of the patients' individual nutrition status, determination of nutrition targets, progressive increase of energy and protein supply throughout the different phases of disease, prevention of micronutrient deficiencies, implementation of nutrition protocols, appropriate monitoring strategies, and continuous quality improvement are essential elements of MNT in patients on MCS.Summary: The importance of MNT for patients on MCS still often remains underrecognized, which might be of particular relevance in view of the significant metabolic alterations, the long treatment period, and severity of illness in these patients. Further research on more targeted MNT approaches in those patients is urgently needed for the generation of evidence-based guidelines for this specific cohort of critically ill patients.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684502","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 minimally invasive cardiac surgery and enhanced recovery after surgery. 微创心脏手术和术后恢复的最新进展。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-10-11 DOI: 10.1097/ACO.0000000000001322

Rawn Salenger, Kevin Lobdell, Michael C Grant

{"title":"Update on minimally invasive cardiac surgery and enhanced recovery after surgery.","authors":"Rawn Salenger, Kevin Lobdell, Michael C Grant","doi":"10.1097/ACO.0000000000001322","DOIUrl":"10.1097/ACO.0000000000001322","url":null,"abstract":"Purpose of review: Numerous recent trials have examined the potential benefits of treating cardiac surgery patients with a minimally invasive approach. Recently, Enhanced Recovery After Surgery (ERAS) has also been applied to cardiac surgery, and specifically to minimally invasive cardiac surgery (MICS) patients. This review will explore current evidence regarding MICS, as well as the combination of MICS plus ERAS.Recent findings: Multiple contemporary prospective and retrospective trials have published data demonstrating equivalent or better outcomes with reduced length of stay (LOS) for MICS patients compared to patients undergoing full sternotomy. In fact, recent reviews and met-analyses suggest that MICS is associated with reduced atrial fibrillation, wound complications, blood transfusion, LOS, and potentially cost. Additionally, several new trials reporting longer term follow-up on MICS coronary and valve surgery have demonstrated durable results. Emerging literature on the benefits of combining MICS and ERAS perioperative protocols have also reported promising results regarding reduced LOS and faster recovery.Summary: Minimally invasive cardiac surgery appears to provide patients with equivalent or better outcomes, faster recovery, and less surgical trauma compared to full sternotomy. The addition of ERAS phase specific perioperative protocols can help maximize the benefits of MICS.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684546","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

Innovative designs for trials informing the care of cardiac surgical patients: Part II. 为心脏外科患者护理提供信息的试验创新设计：第二部分.

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-12-07 DOI: 10.1097/ACO.0000000000001334

Nikola Anusic, Daniel I Sessler

{"title":"Innovative designs for trials informing the care of cardiac surgical patients: Part II.","authors":"Nikola Anusic, Daniel I Sessler","doi":"10.1097/ACO.0000000000001334","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001334","url":null,"abstract":"Purpose of review: This review examines advances in clinical trial methodologies relevant to cardiac anesthesia. It focuses on innovative approaches, including factorial randomization, composite outcomes, and cluster randomized trials, which enhance the efficiency, practical relevance, and generalizability of trial outcomes.Recent findings: Factorial randomization is becoming popular because the approach allows investigators to simultaneously evaluate two or more interventions. Furthermore, factorial designs can evaluate interactions among treatments which is highly relevant information that cannot be obtained from separate trials. Composite outcomes are also increasingly utilized, combining multiple individual outcomes into a single measure, which increases statistical power and can better represent relevant physiology. Designing valid composites requires careful consideration of component outcome severity and incidence. Cluster randomized trials, including stepped wedge and multiple crossover designs, address the challenges of group-level effects and shared environments.Summary: The evolution of clinical trial designs is marked by a shift towards methodologies that enhance efficiency and provide more nuanced insights into treatment effects. These include factorial designs for simultaneous intervention assessment, composite outcomes for comprehensive physiological representation, and cluster trials for group-level effect analysis. Such advancements are shaping the future of clinical research, making it more relevant, efficient, and broadly applicable.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812968","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