Current opinion in anaesthesiology最新文献

Interventional pulmonology: anesthetic management and beyond. 介入肺科：麻醉管理及其他。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-16 DOI: 10.1097/ACO.0000000000001516

Diana Anca, Eugene Shostak, Julien Fessler

{"title":"Interventional pulmonology: anesthetic management and beyond.","authors":"Diana Anca, Eugene Shostak, Julien Fessler","doi":"10.1097/ACO.0000000000001516","DOIUrl":"10.1097/ACO.0000000000001516","url":null,"abstract":"Purpose of review: Interventional pulmonology procedures and techniques advanced at a fast pace in the last decade and intersect pulmonology, interventional radiology, and thoracic surgery for the diagnosis, staging, and treatment of lung diseases. Given the complexity of both procedures and patients, anesthesiologists are an integral part of the team, and familiarity with procedure steps, risks and complications is very important, as it is close collaboration with the proceduralists.Recent findings: Due to the complexity of procedures, such as robotic bronchoscopy, lung ablations, and patients, specific ventilatory strategies need to be employed. Recent advancements in robotic bronchoscopy and intraoperative 3D imaging allow the precise localization of lung nodules. Another major advancement is the pulsed electrical energy ablation into the nodule, inducing cell death. Our anesthetic approach must be tailored to these techniques to minimize atelectasis and risk of fire.Summary: Due to the complexity of new procedures, interventional pulmonology necessitates a careful, patient-tailored, anesthetic approach. The recent advancements in robotic bronchoscopy, lung markings and pulse electrical ablations require specific anesthetic techniques, and knowledge of the procedure steps, risks is crucial. Departments might create interventional pulmonology, bronchoscopy anesthesia teams to improve patient safety and team satisfaction.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"397-403"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The liver reconditioning in critical care medicine. 重症监护支持中的肝脏修复。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001544

Luigi La Via, Christian Zanza, Manfredi Tesauro, Francesca Rubulotta, Raymond Planinsic, Yaroslava Longhitano

{"title":"The liver reconditioning in critical care medicine.","authors":"Luigi La Via, Christian Zanza, Manfredi Tesauro, Francesca Rubulotta, Raymond Planinsic, Yaroslava Longhitano","doi":"10.1097/ACO.0000000000001544","DOIUrl":"10.1097/ACO.0000000000001544","url":null,"abstract":"Purpose of review: Machine perfusion has emerged as a transformative alternative to static cold storage in liver transplantation, necessitating a comprehensive review of current evidence. This article examines recent advances in preservation techniques, therapeutic applications, and future directions of machine perfusion technologies.Recent findings: Clinical trials demonstrate superior outcomes with machine perfusion compared with conventional preservation, particularly for marginal and donation after circulatory death grafts. Different protocols - hypothermic, subnormothermic, and normothermic perfusion - show specific advantages in various clinical settings. Technology enables therapeutic interventions like defatting steatotic livers and administering cell-based therapies. Advanced monitoring systems allow real-time graft function assessment, supporting evidence-based acceptance decisions. Novel developments include artificial intelligence applications, new perfusion solutions, and blockchain technology for standardization.Summary: Machine perfusion represents a significant advancement in liver transplantation, though implementation challenges remain regarding infrastructure, training, and costs. The technology's ability to optimize marginal grafts and enable therapeutic interventions may expand the donor pool. Future research should focus on standardizing protocols, developing cost-effective solutions, and validating emerging technologies for widespread clinical adoption.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"523-532"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Magnesium sulfate and sugammadex: implications for routine practice. 硫酸镁和糖madex：对常规实践的影响。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001507

Thomas Fuchs-Buder, Denis Schmartz, Benoît Plaud

{"title":"Magnesium sulfate and sugammadex: implications for routine practice.","authors":"Thomas Fuchs-Buder, Denis Schmartz, Benoît Plaud","doi":"10.1097/ACO.0000000000001507","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001507","url":null,"abstract":"Purpose of the review: Magnesium sulfate (MgSO4) enhances neuromuscular blockade; it may accelerate onset, prolong clinical duration, and delay neuromuscular recovery. In addition, MgSO4 administration shortly after neuromuscular recovery may lead to the recurrence of neuromuscular blockade. This review aimed to assess the efficacy and safety of sugammadex in both scenarios.Recent findings: Compelling evidence suggests that the dosing and timing of sugammadex administration remain unchanged whether the neuromuscular blockade is induced by rocuronium alone or results from magnesium pretreatment before rocuronium administration. Furthermore, particular caution is required when MgSO4 is administered shortly after recovery from neuromuscular blockade, as the reduced safety margin may lead to the reappearance of neuromuscular blockade. Sugammadex may also counteract this recurrence, provided that the initial neuromuscular blockade was induced by a steroidal neuromuscular blocking agent such as rocuronium or vecuronium.Summary: In both clinical scenarios, sugammadex-induced reversal is rapid and reliable.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"349-352"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nonoperating room anesthesia: opportunities for continued excellence. 非手术室麻醉：持续卓越的机会。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001519

Richard D Urman

引用次数: 0

Navigating the clinical benefits, risks, and emerging controversies with glucagon-like peptide-1 receptor agonists. 胰高血糖素样肽-1受体激动剂的临床益处、风险和新出现的争议。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-30 DOI: 10.1097/ACO.0000000000001522

Sudipta Sen, Sher-Lu Pai, Monica W Harbell

{"title":"Navigating the clinical benefits, risks, and emerging controversies with glucagon-like peptide-1 receptor agonists.","authors":"Sudipta Sen, Sher-Lu Pai, Monica W Harbell","doi":"10.1097/ACO.0000000000001522","DOIUrl":"10.1097/ACO.0000000000001522","url":null,"abstract":"Purpose of review: The purpose of this review is to provide an overview of the current clinical implications, benefits, and controversies surrounding the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs). This review discusses the potential risks associated with GLP-1 RA therapy, such as pulmonary aspirations, tachyphylaxis, and issues with drug efficacy over time.Furthermore, it examines the increasing ethical and medical concerns related to their off-label use, safety, and accessibility.Recent findings: Recent studies highlight significant discrepancies in the recommendations provided by different medical societies on the perioperative management of GLP-1 RAs. In addition, insurance barriers exacerbate access issues, with substantial disparities in coverage for weight loss versus diabetes management. The rise of counterfeit GLP-1 RAs, unintentional overdoses, and the growing concern about long-term health impacts are also prominent challenges in the current landscape.Summary: Despite increasing usage and the potential benefits of GLP-1 RAs, a lack of consensus on optimal perioperative management and long-term use, coupled with financial and regulatory barriers, creates significant challenges. Medical societies differ on key aspects such as fasting requirements and the risk of aspiration, and concerns about the safety of compounded and counterfeit products remain.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"533-539"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Overview and management of hepatorenal syndrome. 肝肾综合征的概述和治疗。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-17 DOI: 10.1097/ACO.0000000000001526

Matthew Sherman, Briana DiSilvio, Tariq Cheema

{"title":"Overview and management of hepatorenal syndrome.","authors":"Matthew Sherman, Briana DiSilvio, Tariq Cheema","doi":"10.1097/ACO.0000000000001526","DOIUrl":"10.1097/ACO.0000000000001526","url":null,"abstract":"Purpose of review: Hepatorenal syndrome (HRS) is an acute kidney injury (AKI) syndrome commonly encountered in critically ill patients with a history of cirrhosis with ascites. Given the complexity of diagnosing and managing this condition, this review aims to highlight the key features of disease pathophysiology along with prevention and treatment modalities to improve patient outcomes.Recent findings: Recent meetings between the acute disease quality initiative and the internal club of ascites have renamed HRS from HRS-1 and HRS-2 to HRS-AKI and HRS-chronic kidney disease. Further changes in diagnostic strategy, largely around the implication and use of albumin resuscitation, have further been addressed and clarified in recent updates from various clinical societies.Summary: HRS represents a challenging disease entity requiring aggressive attempts at prevention, early treatment initiation, and frequent transplant candidacy discussion to improve patient outcomes. The poor prognosis associated with this condition, particularly amongst patients with poor transplant candidacy, requires physicians to maintain high vigilance when managing patients with cirrhosis with acutely reduced renal function. By providing a review of distinct diagnostic criterion, pathophysiology, prevention strategies, and treatment modalities, we aim to provide clinicians with the tools to properly understand and manage this disease state.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"492-497"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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 for outpatient interventional radiology procedures for cancer patients. 癌症患者门诊介入放射治疗的麻醉注意事项。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-20 DOI: 10.1097/ACO.0000000000001515

Natalie B Simon, Joanna Serafin, Suken H Shah, Kara M Barnett

{"title":"Anesthetic considerations for outpatient interventional radiology procedures for cancer patients.","authors":"Natalie B Simon, Joanna Serafin, Suken H Shah, Kara M Barnett","doi":"10.1097/ACO.0000000000001515","DOIUrl":"10.1097/ACO.0000000000001515","url":null,"abstract":"Purpose of review: Interventional radiology (IR) has emerged as a vital component of cancer care, offering minimally invasive procedures for diagnosis, therapy, and palliation. The increasing safety and efficacy of these procedures have led to a surge in their adoption, including in nonoperating room anesthesia and outpatient settings.Recent findings: Cancer patients increasingly present with complex medical histories for outpatient IR procedures and require specialized anesthetic care. The decision to perform an IR procedure in an outpatient setting should be based on careful evaluation of patient and procedure factors as well as facility resources, which varies among outpatient hospital settings, office-based labs, and ambulatory surgery centers. Oftentimes, oncology patients undergo repeated or multiple procedures at various points in their diagnostic and treatment course.Summary: We review the types of settings and cases and the patient selection and anesthetic considerations for outpatient IR procedures in cancer patients. By understanding the unique challenges posed by this patient population, including their increased comorbidity burden, potential treatment-related complications, and the need for tailored anesthetic techniques, anesthesia providers can optimize patient care and minimize perioperative risks.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"383-390"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnostics and management of direct oral anticoagulants-induced bleeding. 直接口服抗凝剂引起出血的诊断和处理。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-26 DOI: 10.1097/ACO.0000000000001531

Christian von Heymann, Arash Afshari, Aamer Ahmed, Eleni Arnaoutoglou, Daniel Bolliger, Oliver Grottke

{"title":"Diagnostics and management of direct oral anticoagulants-induced bleeding.","authors":"Christian von Heymann, Arash Afshari, Aamer Ahmed, Eleni Arnaoutoglou, Daniel Bolliger, Oliver Grottke","doi":"10.1097/ACO.0000000000001531","DOIUrl":"10.1097/ACO.0000000000001531","url":null,"abstract":"Purpose of review: To provide evidence-based management of patients on direct oral anticoagulants (DOAC) needing acute procedures, including those facing hemorrhage.Recent findings: Standard coagulation parameters are insufficient for precise DOAC plasma level measurement; calibrated anti factor X activated assays are reliable, and point-of-care assays may be useful in urgent situations. For intracerebral hemorrhage (ICH) in patients on DOACs, direct reversal strategies seem to be more effective than nonspecific hemostatic agents, but evidence still remains unclear in terms of efficacy and safety compared to nonspecific hemostatic agents. Before invasive procedures like neuraxial anesthesia or cerebral thrombectomy, idarucizumab is recommended for dabigatran-treated patients, despite recent observational data not fully supporting this. No recommendations can be made for FXa inhibitors because of the lack of data.Summary: Clinicians should assess the overall risk of bleeding for an acute procedure or the severity of any ongoing hemorrhage in DOAC-treated patients before initiating any reversal treatment, regardless of current evidence levels.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"353-360"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pharmacological approach to rapid sequence induction/intubation: a contemporary perspective. 快速序列诱导/插管的药理学方法：当代视角。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-28 DOI: 10.1097/ACO.0000000000001528

Massimiliano Sorbello, Daniele Salvatore Paternò, Ivana Zdravkovic, Luigi La Via

{"title":"Pharmacological approach to rapid sequence induction/intubation: a contemporary perspective.","authors":"Massimiliano Sorbello, Daniele Salvatore Paternò, Ivana Zdravkovic, Luigi La Via","doi":"10.1097/ACO.0000000000001528","DOIUrl":"10.1097/ACO.0000000000001528","url":null,"abstract":"Purpose of review: This review examines the evolution of the pharmacological approach to rapid sequence induction/intubation (RSII) over the past 55 years, highlighting recent advances and contemporary perspectives on managing full-stomach patients requiring airway control.Recent findings: While aspiration remains a significant concern during RSII (occurring in 3-6% of cases), recent data suggests that desaturation, hypoxemia, and hemodynamic instability pose even greater risks, particularly in critically ill patients. Modern RSII approaches have evolved significantly from Safar's original protocol. Cricoid pressure is increasingly questioned, with evidence suggesting it may be unnecessary except when active regurgitation is observed. Gentle ventilation postinduction appears safe and beneficial when desaturation risk is high. Regarding pharmacology, succinylcholine has largely been replaced by rocuronium, while ketamine and etomidate are preferred over propofol for hemodynamically unstable patients. glucagon-like peptide 1 agonists may increase residual gastric content but have not definitively been linked to increased aspiration rates. First-pass success (currently ~84%) is crucial, as complications increase exponentially with multiple attempts.Summary: Contemporary RSII should balance aspiration prevention with avoiding hypoxemia and hemodynamic collapse. This requires thorough patient assessment, appropriate drug selection, optimal positioning, and effective teamwork. The priority should be making the first intubation attempt the best possible attempt, with preintubation optimization and consideration of human factors.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"369-374"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The future of target-controlled infusion and new pharmacokinetic models. 靶控输注的未来和新的药代动力学模型。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-26 DOI: 10.1097/ACO.0000000000001529

Anthony R Absalom, Thomas W Schnider

{"title":"The future of target-controlled infusion and new pharmacokinetic models.","authors":"Anthony R Absalom, Thomas W Schnider","doi":"10.1097/ACO.0000000000001529","DOIUrl":"10.1097/ACO.0000000000001529","url":null,"abstract":"Purpose of review: To summarize recent developments in the understanding of the pharmacology of the hypnotic and opioid drugs, with relevance to target-controlled infusions and newer pharmacokinetic models.Recent findings: General-purpose models have been developed for propofol, remifentanil, and dexmedetomidine, suitable for use in a wide variety of patients, but still not universally applicable. A validation study of the predictive performance of the Eleveld propofol model showed reasonable performance in children, healthy adults, and obese adults but poorer performance in elderly patients. Observational studies show that complications during total intravenous anesthesia often arise from omission of basic safety checks and inadequate knowledge, rather than model misspecification. Specifically, there is a lack of understanding of the influence of the clinical situation on the pharmacodynamics of hypnotic drugs. Artificial intelligence is likely to produce useful drug infusion rate advisory systems, or even closed-loop control systems that could potentially provide better patient-individualized titration of anesthetic drugs.Summary: Further efforts to develop new models are unlikely to be clinically beneficial. Efforts should rather be made to ensure better education and a better appreciation of variability in pharmacodynamics and the need for better ways of tailoring drug doses to individual patient needs.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"375-381"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0