Current opinion in anaesthesiology最新文献_第2页

Enhanced recovery after surgery in liver transplantation: the anesthesia perspective. 肝移植术后增强恢复：麻醉视角。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-09 DOI: 10.1097/ACO.0000000000001512

Stefano Skurzak, Yaroslava Longhitano, Bruna Lavezzo, Antonio Voza, Chiara Stratta

{"title":"Enhanced recovery after surgery in liver transplantation: the anesthesia perspective.","authors":"Stefano Skurzak, Yaroslava Longhitano, Bruna Lavezzo, Antonio Voza, Chiara Stratta","doi":"10.1097/ACO.0000000000001512","DOIUrl":"10.1097/ACO.0000000000001512","url":null,"abstract":"Purpose of review: Enhanced recovery after surgery (ERAS) has been introduced as a comprehensive strategy in liver transplantation (LT) in recent years. Guidelines for ERAS in LT are now available and embrace several domains of patient management. The transplant anesthesiologist is called into action through the entire process with particular attention to the maintenance of intraoperative homeostasis, early weaning and discontinuation of invasiveness, and pain control as main determinants of patient well-being.Recent findings: Advanced hemodynamic monitoring and early extubation are established cornerstones of ERAS in LT. There are great expectations for the contribution of regional anesthesia and multimodal analgesia for a comfortable recovery but data are still limited. Leading centers in ERAS have reached considerable results and should serve as a reference for groups starting new programs. Differences in patient listing and prioritization significantly affect patient's conditions and should be accounted for. ERAS in LT will necessarily confront with the advent of mini-invasive surgery (robotic transplantation) in the next years, requiring a flexible approach.Summary: ERAS is a rapidly growing opportunity in the complex setting of LT. Anesthesiologists play a crucial role in several important steps of the process and they are called to give their contribution in terms of vision and further evidences.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"471-477"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268411","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

IFrailty in liver transplantation: implications for perioperative management and postoperative outcomes. 肝移植虚弱：对围手术期处理和术后结果的影响。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-09 DOI: 10.1097/ACO.0000000000001513

Berkay Demirors, Pamela M Bloomer, Michele Molinari

{"title":"IFrailty in liver transplantation: implications for perioperative management and postoperative outcomes.","authors":"Berkay Demirors, Pamela M Bloomer, Michele Molinari","doi":"10.1097/ACO.0000000000001513","DOIUrl":"10.1097/ACO.0000000000001513","url":null,"abstract":"Purpose of the review: Frailty, a multidimensional syndrome characterized by diminished physiological reserve, is a key determinant of outcomes in liver transplantation (LT). Among patients with end-stage liver disease, frailty manifests through physical, cognitive, and psychosocial impairments that complicate perioperative management and hinder recovery. This review explores the pathophysiological underpinnings of frailty, its clinical relevance for transplant teams, and emerging strategies for its assessment and reversal.Recent findings: Frailty affects up to one-third of LT candidates and is independently linked to higher rates of postoperative complications, infections, prolonged ICU stays, and mortality. Objective frailty assessment tools enhance risk stratification and guide individualized interventions. Prehabilitation programs - encompassing exercise, nutritional optimization, and novel therapies such as senolytics and mRNA-based approaches - have shown promise in improving functional status and reducing perioperative risk. At the University of Pittsburgh, structured frailty protocols are fully integrated into LT evaluation and care.Summary: Frailty is a modifiable risk factor with profound implications for LT outcomes. Routine frailty screening, coupled with targeted multidisciplinary interventions, can optimize candidate selection, reduce complications, and improve long-term recovery. Ongoing research is needed to identify and standardize the most effective strategies for reversing frailty in this high-risk population.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"513-522"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268414","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

2025 ISOBS OBA emergency manual: new drugs, devices, diversions, and dysfunction. 2025 ISOBS OBA紧急手册：新药，设备，转移和功能障碍。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-16 DOI: 10.1097/ACO.0000000000001518

Justin Talluto, Nicolette Duong, Vikranth R Chinthareddy, Brian M Osman, Steven K Young, Fred E Shapiro

{"title":"2025 ISOBS OBA emergency manual: new drugs, devices, diversions, and dysfunction.","authors":"Justin Talluto, Nicolette Duong, Vikranth R Chinthareddy, Brian M Osman, Steven K Young, Fred E Shapiro","doi":"10.1097/ACO.0000000000001518","DOIUrl":"10.1097/ACO.0000000000001518","url":null,"abstract":"Purpose of review: Office-based anesthesia (OBA) and surgery continue to grow as hospitals shift procedures to the outpatient setting. The original 2017 Institute for Safety in Office-Based Surgery emergency manual provided guidance for the response of critical events in the office setting. Recent trends in medication use, procedural complexity, and patient comorbidities necessitate an update. This new emergency manual addresses the management of events such as aspiration or ketoacidosis that may be seen with increasing use of glucagon-like peptide-1 receptor agonists (GLP1-RAs) or sodium-glucose cotransporter 2 (SGLT2) inhibitors, workplace violence, malfunctioning of cardiac implantable electronic devices (CIEDs), fat embolism, postoperative airway problems, and postoperative cognitive dysfunction (POCD).Recent findings: Recent literature emphasizes the growing complexity of procedures and patients in OBA. With the rising use of GLP1-RAs, providers must be prepared for the risk of aspiration from delayed gastric emptying. In addition, the prevalence of CIEDs requires emergency preparedness as procedures utilizing electrocauterization enter the office space. Furthermore, postoperative airway complications and POCD are concerning due to increasing patient BMI, risk of anaphylaxis from medications, and increased use of diabetic medications such as GLP1-RAs and SGLT2 inhibitors.Summary: Recent literature on emergencies and medical society recommendations were used to guide the development of the 2025 OBA emergency manual. Further research and emergency reporting are required to reveal future trends and needs.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"391-396"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259867","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 role of veno-venous bypass in liver transplant. 静脉-静脉旁路在肝移植中的作用。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-20 DOI: 10.1097/ACO.0000000000001504

Elena Ahrens, Giorgia Caputo, Raymond Planinsic, Christian Zanza, Yaroslava Longhitano

{"title":"The role of veno-venous bypass in liver transplant.","authors":"Elena Ahrens, Giorgia Caputo, Raymond Planinsic, Christian Zanza, Yaroslava Longhitano","doi":"10.1097/ACO.0000000000001504","DOIUrl":"10.1097/ACO.0000000000001504","url":null,"abstract":"Purpose of review: Veno-venous bypass (VVB) ensures end-organ perfusion and minimizes splanchnic venous congestion during liver transplant procedures. The adoption of the piggyback technique, where flow through the inferior vena cava is preserved, has prompted a decline in the routine use of VVB. Meanwhile, recommendations on VVB use in liver transplantation remain equivocal. This article explores the clinical implications of VVB use in liver transplantation and offers a comprehensive analysis of its benefits and risks in the context of recent surgical advancements.Recent findings: Evidence indicates that patients undergoing complex procedures or with baseline renal dysfunction may benefit from VVB for conventional liver resection, emphasizing the need for careful patient selection. By contrast, small, retrospective studies suggest lower transfusion requirements and improved graft survival when the piggyback approach was used without VVB, but evidence remains sparse. While direct bypass cannulation-associated complications remain a concern, technical advancements have made VVB use increasingly safe.Summary: In conclusion, VVB remains an important tool in selected, high-acuity patients, but offers limited benefit in more stable patients undergoing piggyback liver resection. Large-scale randomized studies are needed to elucidate the benefit of VVB in selected patient populations undergoing procedures with different surgical approaches.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"478-484"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259871","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

Hepatopulmonary syndrome: pathophysiological mechanisms and clinical implications. 肝肺综合征：病理生理机制及临床意义。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001538

Luigi La Via, Elena Ahrens, Antonio Voza, Manfredi Tesauro, Christian Zanza, Yaroslava Longhitano

{"title":"Hepatopulmonary syndrome: pathophysiological mechanisms and clinical implications.","authors":"Luigi La Via, Elena Ahrens, Antonio Voza, Manfredi Tesauro, Christian Zanza, Yaroslava Longhitano","doi":"10.1097/ACO.0000000000001538","DOIUrl":"10.1097/ACO.0000000000001538","url":null,"abstract":"Purpose of review: Hepatopulmonary syndrome (HPS) is a complication of liver disease that affects up to 30% of patients with cirrhosis and portal hypertension and is associated with a more than doubled risk of mortality. This narrative review aims to summarize the pathophysiology and management of HPS, while highlighting indications, timing, and outcomes of liver transplantation as the sole curative therapy.Recent findings: While supplemental oxygen therapy and pharmacological strategies help alleviate symptoms of HPS, including dyspnea, platypnea, orthodeoxia, and fatigue imposed on signs of liver dysfunction, transplantation remains the sole curative approach. Liver transplantation triples 5-year survival in HPS patients irrespective of baseline disease severity. While data on the correlation between arterial partial pressure of oxygen-based disease severity stages and pretransplant waitlist mortality remain equivocal, the introduction of a model for end-stage liver disease exception points has prompted improved posttransplant survival in these patients. Animal studies provide evidence for pharmacological treatment including norfloxacin or methylene blue, however, large-scale trials targeting humans are lacking.Summary: While future studies are warranted to investigate the efficacy of medical and interventional treatment options for HPS, liver transplantation remains the only curative therapy. Transplantation demonstrates excellent outcomes independent of disease severity, while optimal timing requires an individualized approach.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"485-491"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268412","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

Critical care for deceased liver donors. 已故肝脏捐赠者的重症监护。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-16 DOI: 10.1097/ACO.0000000000001537

Gabriele Arrigo, Luigi Barberis, Paola Maria Garrino, Christian Zanza, Fabrizio Racca

{"title":"Critical care for deceased liver donors.","authors":"Gabriele Arrigo, Luigi Barberis, Paola Maria Garrino, Christian Zanza, Fabrizio Racca","doi":"10.1097/ACO.0000000000001537","DOIUrl":"10.1097/ACO.0000000000001537","url":null,"abstract":"Purpose of review: In this article, we review the ICU management of donors after brain death, with a particular focus on liver donors.Recent findings: The demand for transplantable organs far exceeds the available supply, making it crucial to optimize both the quantity and quality of organ procurement. Following brain death, the focus of critical care shifts from patient survival to organ preservation for transplantation. Hemodynamic instability and elevated serum sodium levels have been linked to poorer liver transplant outcomes.Summary: Organs are primarily obtained from donors declared dead based on neurological or circulatory criteria. In this article, we focus on brain-dead donors. The physiological changes that occur after brain death can compromise organ function. Intensivists must recognize these alterations, as some may require targeted treatment. In particular, the primary objective of intensive care management in these patients is to mitigate these changes through supportive measures, including hemodynamic stabilization, endocrine therapy, respiratory and temperature management. These interventions are essential for preserving the function of transplanted organs and optimizing transplantation outcomes. Liver donors should be treated similarly to other organ donors, with particular regard to serum sodium level and adequate volume replacement.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"465-470"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311197","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

Safety of nonoperating room anesthesia: a narrative review. 非手术室麻醉的安全性：一个叙述性的回顾。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001542

Alan D Kaye, Brianna N Rogers, Sydney Mashaw, Chizoba N Mosieri, Richard D Urman, Sahar Shekoohi

{"title":"Safety of nonoperating room anesthesia: a narrative review.","authors":"Alan D Kaye, Brianna N Rogers, Sydney Mashaw, Chizoba N Mosieri, Richard D Urman, Sahar Shekoohi","doi":"10.1097/ACO.0000000000001542","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001542","url":null,"abstract":"Purpose of review: Nonoperating room anesthesia (NORA) has become increasingly relevant as diagnostic and therapeutic procedures move beyond traditional surgical settings. This shift introduces unique safety challenges, making it crucial to evaluate how NORA can maintain patient safety and procedural efficiency despite the lack of standardized environments and resources typical of operating rooms.Recent findings: Studies reveal that NORA often involves patients with complex comorbidities, requiring meticulous risk assessment and preparation. Common challenges include limited equipment availability, difficulties in patient monitoring, and restricted access to emergency support. Portable 3 monitoring devices, streamlined sedation techniques, and advancements in anesthesia technology have contributed to improved safety. However, these advancements underscore the importance of adhering to protocols tailored to the unique needs of each procedural setting.Summary: Addressing NORA's safety challenges requires rigorous preoperative evaluation, adherence to high monitoring standards, and effective communication between anesthesia teams and procedural staff. Further research and standardized guidelines are essential to optimize patient outcomes, minimize risks, and ensure the safe delivery of anesthesia in nontraditional settings. These measures will support the continued evolution and success of NORA in modern healthcare.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"425-434"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593763","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

Sedation technique considerations for nonoperating room anesthesia: a narrative review and update. 非手术室麻醉镇静技术的考虑：叙述回顾和更新。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001541

Alan D Kaye, Brianna N Rogers, Camila Y Carrera, Richard D Urman, Saajid Azhar, Sahar Shekoohi

{"title":"Sedation technique considerations for nonoperating room anesthesia: a narrative review and update.","authors":"Alan D Kaye, Brianna N Rogers, Camila Y Carrera, Richard D Urman, Saajid Azhar, Sahar Shekoohi","doi":"10.1097/ACO.0000000000001541","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001541","url":null,"abstract":"Purpose of review: Sedation techniques for nonoperating room anesthesia (NORA) are vital for ensuring patient comfort and cooperation during diagnostic and therapeutic procedures outside traditional operating rooms. The increasing prevalence of these procedures in diverse settings necessitates adapting sedation practices to unique challenges in monitoring, equipment availability, and emergency preparedness.Recent findings: The choice of sedation technique depends on the procedure, patient health status, and the nonsurgical environment's resources. Common techniques include moderate sedation, deep sedation, and general anesthesia. Agents like propofol, dexmedetomidine, fentanyl, and midazolam are frequently used due to their rapid onset, short half-lives, and predictable three pharmacokinetics. Balanced sedation techniques combining agents help minimize side effects while achieving desired sedation levels.Summary: To maintain safety and efficacy, NORA practices must adhere to the same high standards as operating rooms, including sedation protocols and American Society of Anesthesiologists standard monitoring. Portable monitoring systems and robust emergency preparedness are essential in these settings. As NORA cases rise, the development of tailored sedation protocols and refinement of safety standards are crucial to enhancing patient outcomes in diverse procedural environments.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"435-442"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593764","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

Analgesia for living donor liver transplant: a systematic review of recent trials. 活体供肝移植的镇痛：近期试验的系统回顾。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-28 DOI: 10.1097/ACO.0000000000001525

Francesco Saglietti, Alessandro Girombelli, Veronica Ojetti, Cristian Deana, Francesco Vetrone

引用次数: 0

Closed claims analysis in nonoperating room anesthesia. 非手术麻醉的封闭式索赔分析。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001536

Annika Wanner, Ruben Klimke, Markus M Luedi, Richard D Urman

{"title":"Closed claims analysis in nonoperating room anesthesia.","authors":"Annika Wanner, Ruben Klimke, Markus M Luedi, Richard D Urman","doi":"10.1097/ACO.0000000000001536","DOIUrl":"10.1097/ACO.0000000000001536","url":null,"abstract":"Purpose of review: Nonoperating room anesthesia (NORA) is an evolving field driven by technological advancements that enable minimally invasive procedures outside operating rooms. While expanding access to interventional procedures, NORA environments introduce impcatful challenges, including patient complexity, rapid procedural turnover, preoperative assessment, inconsistent team familiarity, and limited emergency preparedness.Recent findings: Closed claims data analysis provides critical insights into risks associated with NORA procedures. Studies indicate that while overall malpractice claims in NORA remain relatively low, the incidence of claims is significantly higher compared with the operating room cases. Common complications include airway management failures, respiratory depression, and inadequate ventilation, with aspiration pneumonitis occurring nearly twice as often in NORA settings. Furthermore, cardiovascular instability and hemodynamic events are prevalent among high-risk procedures, particularly in cardiology and radiology suites.Summary: Effective risk reduction requires thorough patient selection, the implementation of strict monitoring protocols, and adherence to standardized safety guidelines. Strategies such as enhanced preoperative screening, structured emergency preparedness, and increased utilization of advanced airway management tools like videolaryngoscopy can significantly reduce complications. In addition, implementing site-specific checklists, reinforcing interdisciplinary communication, and improving provider training is inevitable. Refining monitoring technologies and improving closed-loop anesthesia systems offer exciting potential to enhance patient safety.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"418-424"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268406","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