Current opinion in anaesthesiology最新文献_第2页

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

Brain ultrasonography in neurosurgical patients. 神经外科病人的脑超声检查。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001547

Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar

{"title":"Brain ultrasonography in neurosurgical patients.","authors":"Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar","doi":"10.1097/ACO.0000000000001547","DOIUrl":"10.1097/ACO.0000000000001547","url":null,"abstract":"Purpose of review: Brain ultrasound is a popular point-of-care test that helps visualize brain structures. This review highlights recent developments in brain ultrasonography. There is a need to keep pace with the ongoing technological advancements and establishing standardized quality criteria for improving its utility in clinical practice.Recent findings: Newer automated indices derived from transcranial Doppler help establish its role as a noninvasive monitor of intracranial pressure and diagnosing vasospasm/delayed cerebral ischemia. A novel robotic transcranial Doppler system equipped with artificial intelligence allows real-time continuous neuromonitoring. Intraoperative ultrasound assists neurosurgeons in real-time localization of brain lesions and helps in assessing the extent of resection, thereby enhancing surgical precision and safety. Optic nerve sheath diameter point-of-care ultrasonography is an effective means of diagnosing raised intracranial pressure, triaging, and prognostication. The quality criteria checklist can help standardize this technique. Newer advancements like focused ultrasound, contrast-enhanced ultrasound, and functional ultrasound have also been discussed.Summary: Brain ultrasound continues to be a critical bedside tool in neurologically injured patients. With the advent of technological advancements, its utility has widened and its capabilities have expanded, making it more accurate and versatile in clinical practice.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"558-563"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478470","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

PECS blocks: where are we now? PECS街区：我们现在在哪里？

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-07-08 DOI: 10.1097/ACO.0000000000001549

Rafael Blanco

引用次数: 0

Fasting and nutrition in neuroanesthesia and neurocritical care patients. 神经麻醉和神经危重症患者的禁食和营养。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001545

Tara Ramaswamy, Alexander Nagrebetsky, Federico Bilotta

{"title":"Fasting and nutrition in neuroanesthesia and neurocritical care patients.","authors":"Tara Ramaswamy, Alexander Nagrebetsky, Federico Bilotta","doi":"10.1097/ACO.0000000000001545","DOIUrl":"10.1097/ACO.0000000000001545","url":null,"abstract":"Purpose of review: This review synthesizes recent evidence on nutrition management in neuroanesthesia and neurocritical care, emphasizing the role of preoperative optimization, minimizing perioperative fasting, and personalizing postoperative and intensive care nutritional support. These nutritional interventions can improve functional recovery for neurosurgical and neurocritically ill patients.Recent findings: Malnutrition is a major risk factor for adverse outcomes in neurosurgery and neurocritically ill patients. Advancements in preoperative fasting guidelines have shifted towards more flexible approaches, such as allowing clear liquids up to 2 h before surgery and encouraging carbohydrate loading before elective surgery to improve glucose regulation and recovery. Prehabilitation strategies, including protein-rich nutrition and physical activity, improve postoperative recovery, particularly in frail patients. In the neurocritically ill, early enteral nutrition (EN) with low-to-moderate protein and calorie targets improves functional recovery and reduces complications. Recent studies challenge the necessity of prolonged fasting before extubation and ICU procedures. Despite evidence supporting reduced fasting, adherence to protocols remains low.Summary: Advances in perioperative fasting protocols will likely improve recovery for neurosurgical patients. Early EN improves outcomes in neurocritically ill patients, while excessive calorie and protein intake may be detrimental. Addressing implementation barriers remains crucial for optimizing nutrition in neurocritical care.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"569-575"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478471","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

Advancing electroencephalography education in anesthesiology. 推进麻醉学脑电图教育。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-05-26 DOI: 10.1097/ACO.0000000000001521

Joana Berger-Estilita, Sarah Saxena, Mia Gisselbaek

{"title":"Advancing electroencephalography education in anesthesiology.","authors":"Joana Berger-Estilita, Sarah Saxena, Mia Gisselbaek","doi":"10.1097/ACO.0000000000001521","DOIUrl":"10.1097/ACO.0000000000001521","url":null,"abstract":"Purpose of review: Electroencephalography (EEG) monitoring is a powerful tool for optimizing anesthesia depth and improving perioperative neurocognitive outcomes. Despite its potential, EEG adoption remains limited in anesthesiology due to training gaps, perceived complexity, and reliance on processed EEG indices. This review examines current educational strategies and highlights the need for structured EEG education in anesthesia training.Recent findings: Emerging educational methodologies include short, focused teaching sessions, electronic learning modules, simulation-based practice, real-time clinical application with feedback, and self-directed study resources. Deliberate practice, spaced repetition, and competency-based progression have shown significant promise in improving EEG interpretation skills among anesthesiologists. Research remains sparse, but existing evidence indicates that even brief, structured interventions can meaningfully enhance clinical proficiency.Summary: Structured, accessible EEG training programs are critical to demystifying EEG interpretation and integrating its use into standard anesthetic practice. Embedding EEG education into residency curricula by relying on modern educational techniques and promoting faculty development will be essential to ensure anesthesiologists are equipped to use EEG monitoring effectively, ultimately improving patient outcomes.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"576-583"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153205","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

Regional anesthesia in bariatric surgery. 减肥手术中的区域麻醉。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-04-29 DOI: 10.1097/ACO.0000000000001506

Alessandro De Cassai, Serkan Tulgar, Michele Carron, Paolo Navalesi

{"title":"Regional anesthesia in bariatric surgery.","authors":"Alessandro De Cassai, Serkan Tulgar, Michele Carron, Paolo Navalesi","doi":"10.1097/ACO.0000000000001506","DOIUrl":"10.1097/ACO.0000000000001506","url":null,"abstract":"Purpose of review: Obesity presents significant perioperative challenges, particularly in bariatric surgery, where optimizing pain management while minimizing opioid use is crucial. Recent advancements in regional anesthesia (RA) techniques offer potential benefits in enhancing perioperative outcomes for this high-risk population.Recent findings: Current evidence supports the use of RA techniques such as transversus abdominis plane (TAP) block, quadratus lumborum (QL) block, erector spinae plane (ESP) block, and intraperitoneal instillation of local anesthetics in reducing postoperative pain and opioid consumption. While TAP and ESP blocks improve postoperative analgesia, the QL block offers longer-lasting pain relief. Intraperitoneal local anesthetic administration has shown potential in decreasing opioid use and improving respiratory recovery. Additionally, port-site infiltration remains a simple yet effective alternative. However, anatomical challenges in obese patients necessitate optimized ultrasound guidance for successful block placement.Summary: RA is a key component of multimodal analgesia in bariatric surgery, contributing to reduced opioid-related complications and improved recovery. Despite promising findings, further high-quality randomized controlled trials are needed to refine technique selection and enhance clinical outcomes in this patient population.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"611-617"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130017","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

Bias in neuromodulation studies on chronic pain. 慢性疼痛神经调节研究的偏倚。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-08-26 DOI: 10.1097/ACO.0000000000001563

Shyam A Desai, Salim M Hayek

{"title":"Bias in neuromodulation studies on chronic pain.","authors":"Shyam A Desai, Salim M Hayek","doi":"10.1097/ACO.0000000000001563","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001563","url":null,"abstract":"Purpose of review: While bias is an integral part of human behavior, bias in clinical research studies may lead to erroneous study conclusions and potentially negative consequences affecting medical care. Bias may influence multiple stages of clinical research and is remarkably prevalent in industry-sponsored studies. Particularly challenging are neuromodulation studies involving patients with chronic pain, whereby industry sponsorship, physicians' conflicts of interest, and patient factors collide to create a highly complex medium that renders clinical research design and interpretation very intricate. This narrative review aims to explore the various biases that complicate clinical neuromodulation studies on chronic pain and potential bias mitigation strategies.Recent findings: Recent studies have highlighted the influence of industry sponsorship of clinical research and the various types of bias that may occur in designing studies. Biases within device-related industry-sponsored studies, including neuromodulation, have come to the forefront, as have recommendations put forward by societal workgroups on best practices in designing and implementing clinical neuromodulation studies.Summary: This review critically examines the various forms of bias in clinical research, and in particular in relation to neuromodulation studies with a focus on spinal cord stimulation, and on potential means to mitigate such bias.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 5","pages":"674-679"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002753","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

Integrative medicine for chronic pain management: a narrative review. 慢性疼痛管理的中西医结合：叙述性回顾。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-10-01 Epub Date: 2025-08-26 DOI: 10.1097/ACO.0000000000001557

Swathi Rayasam, Anna Woodbury

{"title":"Integrative medicine for chronic pain management: a narrative review.","authors":"Swathi Rayasam, Anna Woodbury","doi":"10.1097/ACO.0000000000001557","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001557","url":null,"abstract":"Purpose of review: To present a broad overview of integrative medicine relevant to the field of pain management, summarize information for pain medicine practitioners, and highlight the possible role and incorporation of integrative medicine in daily practice.Recent findings: From 2002 to 2022, the percentage of American individuals using at least one of seven integrative medicine approaches has increased from 19.2 to 36.7%, including use for pain management. While literature has supported benefits in pain for some approaches, there is less robust evidence for other modalities. Higher risk modalities such as chiropractic manipulation, acupuncture, and supplement use remain controversial. A discussion of practical considerations and recommendations is provided for pain management providers who may encounter patients using integrative medicine or who may want to incorporate it into their practice.Summary: Integrative medicine encompasses a broad range of modalities, which have increased in use over the last two decades. Pain management providers should be educated about and consider including integrative medicine modalities into treatment plans. Risks and benefits of each modality must be considered and discussed with patients.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 5","pages":"694-701"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002706","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