Current opinion in anaesthesiology最新文献

Review of cannabis use and propofol anesthesia: recent insights and clinical implications. 大麻使用和异丙酚麻醉的回顾：最近的见解和临床意义。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-07-01 DOI: 10.1097/ACO.0000000000001548

Ruba Sajdeya, Miriam M Treggiari, Samer Narouze

{"title":"Review of cannabis use and propofol anesthesia: recent insights and clinical implications.","authors":"Ruba Sajdeya, Miriam M Treggiari, Samer Narouze","doi":"10.1097/ACO.0000000000001548","DOIUrl":"10.1097/ACO.0000000000001548","url":null,"abstract":"Purpose of review: We examine recent evidence and clinical implications of pharmacological interactions between cannabis and propofol, perioperative considerations for propofol administration, including dosing adjustments and cardiovascular effects, summarize current recommendations, and propose future research directions.Recent findings: Recent studies revealed associations between chronic cannabis use and higher propofol dose administered for procedural sedation and general anesthesia. While several pharmacokinetic and pharmacodynamic pathways have been proposed to explain these associations, no evidence currently supports causality, and the underlying mechanisms remain unknown. Other clinically relevant considerations for propofol anesthesia in patients who use cannabis include cardiovascular stability, mainly encountered with acute intoxication, and postoperative recovery. Current clinical guidelines recommend universal preoperative cannabis use assessment, postponing elective surgery in acutely intoxicated patients, considering propofol adjustments based on clinical assessment, and providing patient counseling about potential adverse effects.Summary: Current evidence supports the necessity for individualized anesthetic management of cannabis users, advocating comprehensive preoperative assessments, cautious dose adjustments, vigilant intraoperative monitoring, and proactive postoperative management strategies. Further research is needed to corroborate causality, confirm and guide dose adjustment needs, determine perioperative cannabis tapering effects, and elucidate the underlying explanatory mechanisms to establish precise clinical guidelines and ensure patient safety.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"660-668"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12342965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532752","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

The potential role of calcitonin gene-related peptide antagonists for the management of hangover headaches. 降钙素基因相关肽拮抗剂在宿醉头痛治疗中的潜在作用。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-07-23 DOI: 10.1097/ACO.0000000000001553

Sameh M Hakim

{"title":"The potential role of calcitonin gene-related peptide antagonists for the management of hangover headaches.","authors":"Sameh M Hakim","doi":"10.1097/ACO.0000000000001553","DOIUrl":"10.1097/ACO.0000000000001553","url":null,"abstract":"Purpose of review: The purpose of this review is to provide an update on the mechanisms of alcohol-induced headache (AIH) and the potential role of calcitonin gene-related peptide (CGRP) antagonists in the management of AIH.Recent findings: AIH is currently believed to be a state of neurogenic inflammation involving the trigeminovascular nociceptive system. There is evidence that alcohol and its metabolites trigger an intricate cascade of reactions and responses in which the mediators of oxidative stress and CGRP play a pivotal role. Evidence from animal models of AIH indicates that CGRP antagonists could be effective in counteracting the manifestations of AIH. Although CGRP antagonists have been approved for the prevention and treatment of migraine headaches, these agents have not been studied within the clinical context of AIH in humans to date. Moving to phase 1 clinical trials may therefore be warranted to elucidate the potential for using these medications in this clinical setting.Summary: CGRP antagonists could be a promising option for the treatment and prevention of AIHs, but clinical evidence is still lacking. Embarking on phase 1 clinical trials exploring the efficacy and safety of CGRP antagonists for AIH may now be expected to be the upcoming step.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"669-673"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700926","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

Regional anesthesia for peripheral vascular surgery: what does the evidence tell us? 周围血管手术的区域麻醉：证据告诉我们什么？

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-07-18 DOI: 10.1097/ACO.0000000000001551

Jessica J Weeks, Paul A Johnson, Vicente Garcia-Tomas

{"title":"Regional anesthesia for peripheral vascular surgery: what does the evidence tell us?","authors":"Jessica J Weeks, Paul A Johnson, Vicente Garcia-Tomas","doi":"10.1097/ACO.0000000000001551","DOIUrl":"10.1097/ACO.0000000000001551","url":null,"abstract":"Purpose of the review: Regional anesthesia is valuable in peripheral vascular surgery, either as the primary anesthetic or as an adjuvant to general anesthesia. Patients presenting for vascular surgery often have associated comorbidities that increase their risk of complications. Beyond benefits with superior pain control, regional anesthesia techniques have the potential to impact other outcomes.Recent findings: The majority of available evidence continues to be retrospective in nature. On the basis of the results of large data registries and meta-analyses, the use of regional anesthetics for peripheral vascular surgery, including revascularization, arteriovenous fistula creation, and amputations, leads to reduced risk of cardiopulmonary complications, shorter lengths of stay, reduced mortality, and higher patency rates of arteriovenous access at 1 year. Some of these effects are more likely in patients with significant underlying comorbidities.Summary: There is low-to-moderate evidence of improved outcomes with regional anesthetic techniques for peripheral vascular surgery. In spite of it, most patients receive general anesthesia. Recent retrospective studies have challenged the beneficial effect of regional anesthesia on certain outcomes; however, their inherent methodology limitations prevent us from drawing definite conclusions. Institutional culture and expertise likely play a significant role in the utilization of regional anesthesia.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"645-651"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700925","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

Prehospital transfusion of allogeneic blood products: Erratum. 院前输血的异体血液制品：勘误。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-08-26 DOI: 10.1097/ACO.0000000000001556

Cristina Alomar-Dominguez, Johannes Bösch, Dietmar Fries

引用次数: 0

C2 dorsal root ganglion: the central hub for cervicogenic headache. C2背根神经节：颈源性头痛的中枢。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-08-26 DOI: 10.1097/ACO.0000000000001564

Samer Narouze

引用次数: 0

Cognitive rehabilitation for patients with acquired brain injury. 获得性脑损伤患者的认知康复。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-05-20 DOI: 10.1097/ACO.0000000000001520

Francesca Pisano, Gaetano Rizzo, Federico Bilotta

{"title":"Cognitive rehabilitation for patients with acquired brain injury.","authors":"Francesca Pisano, Gaetano Rizzo, Federico Bilotta","doi":"10.1097/ACO.0000000000001520","DOIUrl":"10.1097/ACO.0000000000001520","url":null,"abstract":"Purpose of review: Acquired brain injury (ABI) is a major cause of long-term cognitive and functional disability. This review synthesizes recent findings (2023-2025) on four core rehabilitation strategies - physical exercise, cognitive training, noninvasive brain stimulation, and virtual reality - aimed at enhancing cognitive recovery in patients with ABI.Recent findings: Physical exercise promotes neuroplasticity and facilitates both motor and cognitive improvements, especially when delivered early and tailored to individual profiles. Cognitive rehabilitation, particularly when technology-assisted, has demonstrated greater efficacy in enhancing attention, memory, and executive functions compared with conventional approaches. Noninvasive brain stimulation serves as a valuable adjuvant approach, modulating cognition-related cortical networks and augmenting the efficacy of standard rehabilitation protocols. Virtual reality provides immersive and adaptable environments that improve cognitive performance, patient engagement, and psychosocial well-being.Summary: Current evidence supports the clinical relevance of integrating multimodal, patient-centered rehabilitation approaches for ABI. Standardization of treatment protocols and identification of response predictors are critical to improve accessibility, efficacy, and scalability. These interventions are particularly relevant in perioperative and critical care settings, where early cognitive recovery may significantly influence long-term neurological and functional outcomes.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"591-597"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268407","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

Complications of regional anaesthesia. 局部麻醉的并发症。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-08-26 DOI: 10.1097/ACO.0000000000001535

Paul Paterson, David Burckett-St Laurent, Alasdair Taylor

{"title":"Complications of regional anaesthesia.","authors":"Paul Paterson, David Burckett-St Laurent, Alasdair Taylor","doi":"10.1097/ACO.0000000000001535","DOIUrl":"10.1097/ACO.0000000000001535","url":null,"abstract":"Purpose of review: In recent years, ultrasound-guided regional anaesthesia has become more widely available. Despite this, only around one fifth of consultant anaesthetists in the UK feel able to perform all the commonly used blocks. One significant reason for this is concern over the perceived complications of regional anaesthesia. This review provides up-to-date estimates of risk and considers issues raised in the latest literature on the topic.Recent findings: Recent developments include guidelines for local anaesthetic toxicity, a novel method to classify block failure, and recommendations regarding team communication and use of safety devices. Regional anaesthesia continues to be safe, with recent case reports extending its applicability to higher risk situations. Examples include spinal anaesthesia at thoracic levels and in significant aortic stenosis.Summary: Widespread adoption of safety technology and use of pre-existing and novel communication tools will continue to optimise the safety of regional anaesthesia. Standardisation of the reporting of complications of regional anaesthesia could improve this further.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"638-644"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268408","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

High-definition ultrasound in regional anesthesia. 高清超声在区域麻醉中的应用。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-05-30 DOI: 10.1097/ACO.0000000000001534

Graeme A McLeod, Miguel A Reina, André P Boezaart

{"title":"High-definition ultrasound in regional anesthesia.","authors":"Graeme A McLeod, Miguel A Reina, André P Boezaart","doi":"10.1097/ACO.0000000000001534","DOIUrl":"10.1097/ACO.0000000000001534","url":null,"abstract":"Purpose of review: Ultrasound has become the standard imaging technique for regional anesthesia. Traditional guidelines discourage direct needle-nerve contact to prevent fascicle impalement and nerve injury from high-pressure injections. However, despite its widespread usage, efficacy remains inconsistent, with significant rates of secondary continuous block failure and unchanged side-effect profiles. Current ultrasound (8-14 MHz) provides insufficient resolution to reliably differentiate nerve structures from surrounding tissues, particularly in patients with conditions affecting tissue differentiation, such as rheumatoid arthritis.Recent findings: Recent microultrasound studies (>30 MHz) challenge conventional paradigms by revealing multiple fascicles and distinct adipose tissue compartments that are critical for anesthetic distribution. These studies indicate that the needle-tip location relative to adipose tissue, rather than mere proximity to nerves, dictates clinical outcomes. Intraneural injections into adipose compartments seem to be common and clinically beneficial, in contrast to traditional beliefs that associate intraneural injections exclusively with harm.Summary: Innovative technologies such as ultra-high-resolution ultrasound and fiber-optic needle integration promise significantly improved visualization and accurate pressure monitoring for precise anesthetic placement. Until these technologies mature, a combined approach that utilizes ultrasound for anatomical guidance and nerve stimulation to confirm accurate needle and catheter positioning is recommended to enhance block reliability and patient safety.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"652-659"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268413","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

Remimazolam in neuroanesthesia. 雷马唑仑在神经麻醉中的应用。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-05-28 DOI: 10.1097/ACO.0000000000001524

Igor Abramovich, Chanhung Z Lee, Federico Bilotta

{"title":"Remimazolam in neuroanesthesia.","authors":"Igor Abramovich, Chanhung Z Lee, Federico Bilotta","doi":"10.1097/ACO.0000000000001524","DOIUrl":"10.1097/ACO.0000000000001524","url":null,"abstract":"Purpose of review: Remimazolam is a novel ultrashort-acting benzodiazepine that has recently gained attention for its potential benefits in neuroanesthesia. This review aims to critically assess the latest evidence regarding its hemodynamic properties, neurophysiological monitoring compatibility, and recovery profile while highlighting gaps in research and clinical uncertainties.Recent findings: Several randomized controlled trials and case reports suggest that remimazolam may reduce episodes of hypotension, minimize vasopressor use, and facilitate quicker emergence, especially with flumazenil reversal, when compared with other anesthetics. Nonetheless, the agent's tendency to produce higher bispectral index readings at equivalent sedation levels raises questions about monitoring accuracy. In addition, its long-term safety profile and effectiveness across diverse patient populations remain incompletely understood. The possibility of tolerance development and lack of standardized dosing protocols further underscore the need for more robust, large-scale evaluations.Summary: Although remimazolam has shown promise in providing a favorable hemodynamic profile and rapid recovery in neuroanesthesia, definitive conclusions would require additional high-quality, multicenter trials with standardized methodologies. Clinicians should exercise careful judgment in dosing and monitoring till more comprehensive safety and efficacy data are available, to ensure that remimazolam's potential benefits are cautiously utilized based on evolving evidence.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"547-552"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268419","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

Biomarkers of acute brain injury. 急性脑损伤的生物标志物。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-05-26 DOI: 10.1097/ACO.0000000000001532

Katarzyna Prus, Michał Sekuła, Federico Bilotta

{"title":"Biomarkers of acute brain injury.","authors":"Katarzyna Prus, Michał Sekuła, Federico Bilotta","doi":"10.1097/ACO.0000000000001532","DOIUrl":"10.1097/ACO.0000000000001532","url":null,"abstract":"Purpose of the review: Acute brain injuries are the leading cause of morbidity and disability worldwide. Lately, we have observed significant advances in neuroimaging, which have resulted in improved radiological diagnostics; however, laboratory biomarkers of central nervous system (CNS) injury are still not part of routine workup.Recent findings: Numerous studies proposed potential acute brain injury biomarker candidates. New data extend the use of well-known CNS-derived proteins and enzymes to acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage patients. The growing interest in microRNA (miRNA) profiling brings encouraging results for its possible utility as a biomarker of CNS injury in clinical practice. New data are also reported in the area of inflammatory markers - both well-studied and new proposed agents, such as growth differentiation factor 15, demonstrate promising perspectives to be used in prognostication following traumatic brain injury. More researchers propose combined biomarker test panels including proteins, miRNA, and inflammatory parameters, to increase the sensitivity and specificity of assessments.Summary: This review aimed to present recent findings on acute brain injury biomarkers that could be implemented in the management of neurocritical patients. Researchers report data on new potential CNS injury biomarker candidates that must still be validated and standardized in large randomized trials.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"584-590"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268405","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