Current opinion in anaesthesiology最新文献_第3页

'Fulminant hepatic failure' anesthesiologic considerations. “暴发性肝衰竭”的麻醉考虑。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-26 DOI: 10.1097/ACO.0000000000001530

Luigi Vetrugno, Francesco Alessandri, Antonio Toscano, Antonio Voza, Cristian Deana

{"title":"'Fulminant hepatic failure' anesthesiologic considerations.","authors":"Luigi Vetrugno, Francesco Alessandri, Antonio Toscano, Antonio Voza, Cristian Deana","doi":"10.1097/ACO.0000000000001530","DOIUrl":"10.1097/ACO.0000000000001530","url":null,"abstract":"Purpose of review: The aim is to summarize perioperative management of patients with acute liver failure (ALF).Recent findings: The risk of mortality has decreased due to advancements in supportive care and the admission of ALF patients to the ICU. Noninvasive intracranial pressure monitoring is now preferred over invasive methods. Alternatives like transcranial Doppler have emerged, and treatments such as hypertonic saline and mannitol have proven effective in reducing intracranial hypertension (ICH), a common cause of death in these cases. In contrast, invasive hemodynamic monitoring may be necessary to optimize fluid management and the use of vasopressors or inotropes. Norepinephrine should be the first-choice vasopressor for hemodynamic support. Acute kidney injury frequently occurs in patients with ALF and often necessitates the early initiation of renal replacement therapy (RRT). RRT also helps clear hyperammonemia, which can enhance ICH control. Furthermore, coagulation management should rely on point-of-care viscoelastic tests rather than traditional lab tests, as this provides a more accurate assessment of thrombotic or hemorrhagic risks during ALF.Summary: Multiorgan failure associated with ALF requires rapid and aggressive treatment to mitigate the risk of fatal outcomes. Key issues that must be effectively managed include encephalopathy, brain edema, severe coagulopathy, hemodynamic instability, and acute kidney injury.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"503-512"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288049","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

A review of novel structural heart procedures for the anesthesiologist. 麻醉师对新型心脏结构手术的回顾。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001543

Andrea Graham, Ethan Y Brovman

{"title":"A review of novel structural heart procedures for the anesthesiologist.","authors":"Andrea Graham, Ethan Y Brovman","doi":"10.1097/ACO.0000000000001543","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001543","url":null,"abstract":"Purpose of review: There has been significant growth in the volume, complexity, and types of transcatheter cardiac interventions for valvular heart disease over the last 10 years. This review is intended to cover both common structural heart procedures, as well as recent advancements, and the anesthetic considerations of these procedures.Recent findings: While contextualizing within a historical perspective, the review covers mitral and tricuspid valve transcatheter edge-to-edge repair, transcatheter mitral, and tricuspid valve replacement, with focus on valve-in-valve, valve-in-ring, and valve-in-native procedures, laceration of the anterior mitral leaflet to prevent outflow obstruction, septal scoring along the midline endocardium, transcatheter aortic valve implantation with focus on bioprosthetic, or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction. Procedures reviewed are summarized in Table 1.Summary: To provide comprehensive care, anesthesiologists should have an understanding of the indications, population, and key procedural steps of novel structural heart interventions.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"409-417"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593758","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

Portopulmonary hypertension: diagnosis and preoperative management. 门脉性肺动脉高压：诊断与术前处理。

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001527

David W Wang, Akira Katayama, Marianne M Ligon, Ezeldeen Abuelkasem

{"title":"Portopulmonary hypertension: diagnosis and preoperative management.","authors":"David W Wang, Akira Katayama, Marianne M Ligon, Ezeldeen Abuelkasem","doi":"10.1097/ACO.0000000000001527","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001527","url":null,"abstract":"Purpose of review: Preoperative management of portopulmonary hypertension (PoPH) has been difficult to establish because the prevalence of PoPH is relatively low. In recent years, however, several studies have provided new insights into this area. This review outlines the diagnosis and preoperative management of PoPH in light of the latest findings.Recent findings: In a recent retrospective study including 723 patients who underwent liver transplantation, preoperative evaluation of right ventricular systolic pressure on transthoracic echocardiography (TTE) was well correlated with mean pulmonary arterial pressure on right heart catheterization (RHC). TTE can play an important role for screening patients with a higher likelihood of pulmonary hypertension before undergoing more invasive diagnostic testing with RHC.Summary: Liver transplantation for patients with irreversible PoPH is contraindicated. Early diagnosis and appropriate therapeutic interventions in patients with PoPH are crucial to prevent disease progression and improve patient prognosis.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"445-451"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593762","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 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。

Current opinion in anaesthesiology Pub 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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","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

Enhanced recovery after surgery in ambulatory procedures. 加强门诊手术后的恢复。

Current opinion in anaesthesiology Pub Date : 2025-07-18 DOI: 10.1097/ACO.0000000000001552

Juan P Cata, Daniel S Cukierman, Silvia Natoli

{"title":"Enhanced recovery after surgery in ambulatory procedures.","authors":"Juan P Cata, Daniel S Cukierman, Silvia Natoli","doi":"10.1097/ACO.0000000000001552","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001552","url":null,"abstract":"Purpose of review: The expansion of ambulatory surgeries has increased the demand for efficient, safe, and patient-centered perioperative strategies. Enhanced recovery after surgery principles offer a structured framework to streamline ambulatory care. This review highlights recent evidence and advancements in the management of patients undergoing ambulatory procedures.Recent findings: Recent evidence has broadened the anesthetic armamentarium for ambulatory enhanced recovery pathways. Hypnotics such as remimazolam and ciprofol show promising safety profiles in select patient populations. Adjunct anesthetics, including low-dose ketamine, low-dose dexmedetomidine, and methadone, are increasingly being studied for opioid sparing analgesia. Other advances include Bispectral index-guided closed-loop systems, refined antiemetic strategies, and patient-centered recovery metrics to guide discharge readiness.Summary: Current evidence endorses the utilization of enhanced recovery protocols for ambulatory anesthesia, with anesthesiologists assuming a pivotal role. Additional research is required to assess newer agents within these enhanced recovery frameworks, establish standardized patient-centered outcome measures, and incorporate real-time audit tools.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700924","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

Tracheal intubation techniques in head and neck surgery. 头颈部手术中的气管插管技术。

Current opinion in anaesthesiology Pub Date : 2025-07-18 DOI: 10.1097/ACO.0000000000001550

Michael Seltz Kristensen, Camilla Strøm, Martin Petzoldt

{"title":"Tracheal intubation techniques in head and neck surgery.","authors":"Michael Seltz Kristensen, Camilla Strøm, Martin Petzoldt","doi":"10.1097/ACO.0000000000001550","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001550","url":null,"abstract":"Purpose of the review: Despite the rapid emergence of new technologies, tracheal intubation still poses pertinent challenges and remains a key driver for anesthesia-related adverse outcomes in head and neck surgery. This is related to the high incidence of obstructive and space-consuming lesions, tumors, anatomical abnormalities, and oropharyngeal bleeding. Awake or asleep tracheal intubation using direct laryngoscopy, videolaryngoscopy, flexible or rigid endoscopy, videotubes and video stylets, anterior commissure scopes, or ante- and retrograde transtracheal intubation are used to tackle difficult tracheal intubation, but novel technologies and strategies are expected to widen our armamentarium in the near future.Recent findings: Current research and clinical and educational concepts focus on technical and nontechnical skills, new devices, smart combinations of established devices, and evidence-based approaches. Team interaction and crew resource management are paramount. Novel preventive strategies, validated risk prediction, decision-making, and classification tools were developed to increase patients' safety and to meet the needs of rapid digital transformation in airway management.Summary: Targeted, context-specific use of tracheal intubation techniques is pivotal for effective airway management in head and neck surgery. A thorough understanding of various intubation techniques and strategies and proficiency in their application is essential for optimizing airway management, reducing complications, and ensuring patient safety.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700927","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？

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

Rafael Blanco

引用次数: 0

Transfusion strategies in neuroanaesthesia and neurocritical care. 神经麻醉和神经危重症护理中的输血策略。

Current opinion in anaesthesiology Pub Date : 2025-07-04 DOI: 10.1097/ACO.0000000000001523

Alessandro Scudellari, Federico Bilotta

{"title":"Transfusion strategies in neuroanaesthesia and neurocritical care.","authors":"Alessandro Scudellari, Federico Bilotta","doi":"10.1097/ACO.0000000000001523","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001523","url":null,"abstract":"Purpose of review: This review examines the evolving evidence regarding optimal transfusion strategies in neurosurgical populations, addressing the critical balance between maintaining cerebral oxygen delivery and avoiding transfusion-associated complications. The unique physiological vulnerability of the injured brain necessitates reevaluation of conventional transfusion thresholds derived from general critical care populations.Recent findings: Recent multicenter randomized controlled trials have demonstrated heterogeneous effects of liberal vs. restrictive transfusion strategies across different neurological pathologies. In traumatic brain injury (TBI), the HEMOTION and TRAIN trials suggest potential benefits of liberal strategies (hemoglobin thresholds of 9-10 g/dl) for neurological recovery and reduction in cerebral ischemic events. Conversely, the Subarachnoid Hemorrhage Red Cell Transfusion Strategies and Outcome trial in aneurysmal subarachnoid hemorrhage found no significant difference between liberal (≤10 g/dl) and restrictive (≤8 g/dl) strategies regarding unfavorable neurological outcomes. Evidence for optimal hemoglobin thresholds in brain tumor surgery remains limited by the absence of large randomized trials.Summary: The emerging evidence challenges the universal application of restrictive transfusion practices in neurocritical care, suggesting that optimal transfusion thresholds may be pathology-specific. While liberal strategies may benefit TBI patients, equivalent outcomes with restrictive approaches in subarachnoid hemorrhage indicate the need for nuanced, evidence-based protocols tailored to specific neurological conditions.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629303","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

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。

Current opinion in anaesthesiology Pub 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":"https://doi.org/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":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532752","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

Update on scalp nerve block for craniotomy. 开颅术中头皮神经阻滞的最新进展。

Current opinion in anaesthesiology Pub Date : 2025-06-27 DOI: 10.1097/ACO.0000000000001546

Anna Maria Bombardieri, Maxim Pochebyt, Mark A Burbridge

引用次数: 0