Current opinion in anaesthesiology最新文献_第10页

Cell salvage in trauma. 创伤中的细胞抢救。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001014

Jonathan H Waters

引用次数: 2

Anaesthesia for minimally invasive cardiac procedures in the catheterization lab. 导管实验室微创心脏手术的麻醉。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001007

Catherine Reid, Massimiliano Meineri, Thomas Riva, Thomas Pilgrim, Lorenz Räber, Markus M Luedi

引用次数: 1

Recent advances in understanding cognitive and behavioural alterations after early-in-life anaesthesia exposure and new mitigation/alternative strategies in preclinical studies. 了解早期麻醉暴露后认知和行为改变的最新进展以及临床前研究中的新缓解/替代策略。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001016

Viola Neudecker, Jose F Perez-Zoghbi, Ansgar M Brambrink

{"title":"Recent advances in understanding cognitive and behavioural alterations after early-in-life anaesthesia exposure and new mitigation/alternative strategies in preclinical studies.","authors":"Viola Neudecker, Jose F Perez-Zoghbi, Ansgar M Brambrink","doi":"10.1097/ACO.0000000000001016","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001016","url":null,"abstract":"Purpose of review: Long-term behavioural and cognitive impairments after exposure to general anaesthetics during infancy is an intensely investigated and controversial topic. Recent clinical studies with prospective assessments associate exposure with long-term behavioural alterations rather than cognitive impairments. This review aims to provide an understanding of the long-term cognitive impairments and behavioural alterations found in recent animal studies and to summarize latest advances in strategies to protect against anaesthesia-induced developmental neurotoxicity (AIDN).Recent findings: Preclinical studies, particularly those in nonhuman primates (NHPs), provide accumulating evidence that anaesthesia exposure during infancy is associated with long-term alterations in behaviour, but cognitive impairments are more controversial. Results from recent studies aiming to find mitigating strategies to reduce AIDN or to identify alternative anaesthetic agents include the co-administration of dexmedetomidine with the anaesthetic drugs or the alternative use of hypnotic neurosteroids without being harmful to the developing brain.Summary: Recent findings in animal studies with translational relevance support the proposed association between early-in-life anaesthesia exposure and long-term alterations in behaviour. Studies aiming to prevent AIDN are promising and need evaluation in the NHP model. The careful design of subsequent translational studies will be critical to advance the field forward towards safer anaesthesia exposure in children.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"402-408"},"PeriodicalIF":2.5,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39010426","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: 5

Updates and controversies in anesthesia for advanced interventional pulmonology procedures. 高级介入肺科手术麻醉的最新进展和争议。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001029

Basem B Abdelmalak, D John Doyle

{"title":"Updates and controversies in anesthesia for advanced interventional pulmonology procedures.","authors":"Basem B Abdelmalak, D John Doyle","doi":"10.1097/ACO.0000000000001029","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001029","url":null,"abstract":"Purpose of review: Advanced bronchoscopic procedures continues to grow, and are now commonly used to diagnose and/or treat a variety of pulmonary conditions that required formal thoracic surgery in past decades. Pharmacologic developments have provided new therapeutic options, as have technical advances in both anesthesia and interventional pulmonology. This review discusses technical and clinical issues and advances in providing anesthesia for advanced bronchoscopic procedures. It also discusses some controversial issues that have yet to be fully resolved.Recent findings: We discuss anesthetic considerations for new procedures such as the new technology used in electromagnetic navigation bronchoscopy, and bronchoscopic cryotherapy. We also review new ventilation strategies as well as pharmacologic advances and recent trends in the utilization of anesthetic adjuvants, and the use of short-acting opioids like remifentanil, and alpha agonist sedatives such as dexmedetomidine.Summary: The anesthetic framework and the discussions presented here should help forge effective communication between the interventional pulmonologist and the anesthesiologist In the Bronchoscopy Suite nonoperating room anesthesia with the goal of enhancing patient safety.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"455-463"},"PeriodicalIF":2.5,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39248508","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: 2

Advanced endoscopic gastrointestinal techniques for the bariatric patient: implications for the anesthesia provider. 肥胖患者的先进内镜胃肠道技术:对麻醉提供者的影响。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001021

Andrew Kim, Joshua A Spiro, Thomas J Hatzidais, Norman D Randolph, Rosie Q Li, Diana Ayubcha, Mark S Weiss

{"title":"Advanced endoscopic gastrointestinal techniques for the bariatric patient: implications for the anesthesia provider.","authors":"Andrew Kim, Joshua A Spiro, Thomas J Hatzidais, Norman D Randolph, Rosie Q Li, Diana Ayubcha, Mark S Weiss","doi":"10.1097/ACO.0000000000001021","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001021","url":null,"abstract":"Purpose of review: The incidence of obesity and the use of endoscopy have risen concurrently throughout the 21st century. Bariatric patients may present to the endoscopy suite for primary treatments as well as preoperatively and postoperatively from bariatric surgery. However, over the past 10 years, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as viable alternatives to more invasive surgical approaches for weight loss.Recent findings: The United States Food and Drug Administration (FDA) has approved several different gastric EBMTs including aspiration therapy, intragastric balloons, and endoscopic suturing. Other small intestine EBMTs including duodenal mucosal resurfacing, endoluminal magnetic partial jejunal diversion, and Duodenal-Jejunal Bypass Liner are not yet FDA approved, but are actively being investigated.Summary: Obesity causes anatomic and physiologic changes to every aspect of the human body. All EBMTs have specific nuances with important implications for the anesthesiologist. By considering both patient and procedural factors, the anesthesiologist will be able to perform a safe and effective anesthetic.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"490-496"},"PeriodicalIF":2.5,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39005200","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

Advances in anesthetic and obstetric management of patients with placenta accreta spectrum. 增生性胎盘患者的麻醉和产科管理进展。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-06-01 DOI: 10.1097/ACO.0000000000000985

Jessica Merrill, Pervez Sultan, Nadir Sharawi

{"title":"Advances in anesthetic and obstetric management of patients with placenta accreta spectrum.","authors":"Jessica Merrill, Pervez Sultan, Nadir Sharawi","doi":"10.1097/ACO.0000000000000985","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000985","url":null,"abstract":"Purpose of review: The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist.Recent findings: Recent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. Neuraxial anesthesia as a primary technique is increasingly being used despite the known risk of major bleeding. The use of viscoelastic testing and endovascular interventions may aid hemostatic resuscitation and improve outcomes.Summary: Accurate diagnosis and early antenatal planning among team members are essential. Obstetric anesthesiologists should be prepared to manage a massive hemorrhage, transfusion, and associated coagulopathy. Increasingly, viscoelastic tests are being used to assess coagulation status and the ability to interpret these results is required to guide the transfusion regimen. Balloon occlusion of the abdominal aorta has been proposed as an intervention that could improve outcomes in women with placenta accreta spectrum, but high-quality safety and efficacy data are lacking.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"260-268"},"PeriodicalIF":2.5,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38939054","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: 2

Endocrine emergencies in anesthesia. 麻醉中的内分泌急症。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-06-01 DOI: 10.1097/ACO.0000000000000986

Claudia Fernandez-Robles, Zyad J Carr, Adriana D Oprea

引用次数: 2

Perioperative thrombocytopenia. 围手术期血小板减少。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-06-01 DOI: 10.1097/ACO.0000000000000999

Frederick W Lombard, Wanda M Popescu, Adriana D Oprea, Miklos D Kertai

{"title":"Perioperative thrombocytopenia.","authors":"Frederick W Lombard, Wanda M Popescu, Adriana D Oprea, Miklos D Kertai","doi":"10.1097/ACO.0000000000000999","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000999","url":null,"abstract":"Purpose of review: In this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia.Recent findings: Large contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic platelet transfusion is limited and refractoriness to platelet transfusion is common. A number of options exist to optimize platelet counts prior to procedures, which include steroids, intravenous immunoglobulin, thrombopoietin receptor agonists, and monoclonal antibodies. In addition, intraoperative alternatives and adjuncts to transfusion should be considered. It appears reasonable to use prophylactic desmopressin and antifibrinolytic agents, whereas activated recombinant factor VII could be considered in severe bleeding. Other options include enhancing thrombin generation with prothrombin complex concentrate or increasing fibrinogen levels with fibrinogen concentrate or cryoprecipitate.Summary: Given the lack of good quality evidence, much research remains to be done. However, with a multidisciplinary multimodal perioperative strategy, the risk of bleeding can be decreased effectively.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"335-344"},"PeriodicalIF":2.5,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38948871","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: 1

Myocardial injury after noncardiac surgery - an update. 非心脏手术后心肌损伤——最新进展。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-06-01 DOI: 10.1097/ACO.0000000000000981

Wojciech Szczeklik, Jakub Fronczek

{"title":"Myocardial injury after noncardiac surgery - an update.","authors":"Wojciech Szczeklik, Jakub Fronczek","doi":"10.1097/ACO.0000000000000981","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000981","url":null,"abstract":"Purpose of review: After successfully reducing mortality in the operating room, the time has come for anesthesiologists to conquer postoperative complications. This review aims to raise awareness about myocardial injury after noncardiac surgery (MINS), its definition, diagnosis, clinical importance, and treatment.Recent findings: MINS, defined as an elevated postoperative troponin judged to be due to myocardial ischemia (with or without ischemic features), occurs in up to one in five patients having noncardiac surgery and is responsible for 16% of all postoperative deaths within 30 days of surgery. New evidence on risk factors, etiology, potential prevention strategies, treatment options, and the economic impact of MINS highlights the actionability of perioperative clinicians in caring for adult patients who are considered to be at risk of cardiovascular complications.Summary: Millions of patients safely going through surgery suffer MINS and die shortly after the procedure every year. Without a structured approach to predicting, preventing, diagnosing, and treating MINS, we lose the opportunity to provide our patients with the best chance of deriving benefit from noncardiac surgery. The perioperative community needs to come together, appreciate the clinical relevance of MINS, and step up with high-quality research in the future.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"381-386"},"PeriodicalIF":2.5,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38948873","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: 3

Perioperative risk assessment - focus on functional capacity. 围手术期风险评估-关注功能能力。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-06-01 DOI: 10.1097/ACO.0000000000000988

Ciara Hanley, Duminda N Wijeysundera

{"title":"Perioperative risk assessment - focus on functional capacity.","authors":"Ciara Hanley, Duminda N Wijeysundera","doi":"10.1097/ACO.0000000000000988","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000988","url":null,"abstract":"Purpose of review: This review examines how functional capacity informs preoperative risk stratification, as well as strengths and limitations of options for estimating functional capacity.Recent findings: Functional capacity (or cardiopulmonary fitness) overlaps with other important characteristics, including muscular strength, balance, and frailty. Poor functional capacity is associated with postoperative morbidity, especially noncardiovascular complications. Both patient interviews and exercise tests are used to assess functional capacity. The usual approach of an unstructured patient interview does not predict outcomes. Structured interviews that incorporate validated questionnaires (Duke Activity Status Index) or standardized questions about physical activity (ability to climb stairs) do predict moderate-or-severe complications and cardiovascular complications. Among exercise tests, cardiopulmonary exercise testing (CPET) has shown the most consistent association with risks of complications. Other tests (6-min walk test, incremental shuttle walk test, stair climbing) might predict complications, but still require further high-quality evaluation.Summary: A straightforward way to better assess functional capacity is a structured interview with validated questionnaires or standardized questions about physical activities. Functional capacity can also be assessed by exercise tests, with the strongest evidence supporting CPET. Although some simpler exercise tests have shown promise, more research remains needed to better define their role in preoperative evaluation.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"309-316"},"PeriodicalIF":2.5,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38939499","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: 7