Argyro Zoumprouli, Richard Carden, Federico Bilotta
{"title":"Current and novel approaches for critical care management of aneurysmal subarachnoid hemorrhage in critical care.","authors":"Argyro Zoumprouli, Richard Carden, Federico Bilotta","doi":"10.1097/ACO.0000000000001533","DOIUrl":"10.1097/ACO.0000000000001533","url":null,"abstract":"<p><strong>Purpose of the review: </strong>This review highlights recent advancements and evidence-based approaches in the critical care management of aneurysmal subarachnoid hemorrhage (aSAH), focusing on developments from the past 18 months. It addresses key challenges [rebleeding prevention, delayed cerebral ischemia (DCI), hydrocephalus, transfusion strategies, and temperature management], emphasizing multidisciplinary care and personalized treatment.</p><p><strong>Recent findings: </strong>Recent studies underscore the importance of systolic blood pressure control (<160 mmHg) to reduce rebleeding risk before aneurysm securing. Novel prognostic tools, including the modified 5-item frailty index and quantitative imaging software, show promise in improving outcome prediction. Prophylactic lumbar drainage may reduce DCI and improve neurological outcomes, while milrinone and computed tomography perfusion-guided therapies are being explored for vasospasm management. Transfusion strategies suggest a hemoglobin threshold of 9 g/dl may optimize outcomes. Temperature management remains contentious, but consensus recommends maintaining normothermia (36.0-37.5 °C) with continuous monitoring.</p><p><strong>Summary: </strong>Advances in aSAH care emphasize precision medicine, leveraging technology [e.g. Artificial intelligence (AI), quantitative imaging], and multidisciplinary collaboration. Key unresolved questions warrant multicenter trials to validate optimal blood pressure, transfusion, and temperature targets alongside emerging therapies for DCI.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"541-546"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268409","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}
{"title":"Enhanced recovery after neurosurgery.","authors":"Robert Canelli, Paul Karim, Federico Bilotta","doi":"10.1097/ACO.0000000000001510","DOIUrl":"10.1097/ACO.0000000000001510","url":null,"abstract":"<p><strong>Purpose of review: </strong>The enhanced recovery after surgery (ERAS) approach to the surgical patient optimizes perioperative care to improve outcomes and facilitate recovery. Despite the success of ERAS in many surgical specialties, neurosurgery has been reluctant to adopt ERAS. The aim of this review was to examine recently published ERAS protocols for elective neurosurgical procedures with a focus on brain and spine surgeries.</p><p><strong>Recent findings: </strong>There were few ERAS protocols published for brain and spine surgery in comparison to other surgical specialties. ERAS elements specific to brain surgery seem to address thromboprophylaxis planning, antiepileptic management, steroid administration, strict blood pressure control, and avoidance of mannitol. When implemented, protocols have yielded similar results to protocols for other surgical specialties, including reduced morbidity, hospital length of stay, and health care cost. However, widespread implementation was limited by difficulties in obtaining a consensus agreement on ERAS elements to include, achieving adoption across neurosurgeons, and protocol adherence.</p><p><strong>Summary: </strong>While the adoption of ERAS in neurosurgery remains limited, emerging evidence supports its feasibility and effectiveness, particularly in reducing hospitalization costs and postoperative complications.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"553-557"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259869","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}
Anna Maria Bombardieri, Maxim Pochebyt, Mark A Burbridge
{"title":"Update on scalp nerve block for craniotomy.","authors":"Anna Maria Bombardieri, Maxim Pochebyt, Mark A Burbridge","doi":"10.1097/ACO.0000000000001546","DOIUrl":"10.1097/ACO.0000000000001546","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to outline the indications, technique, and ideal local anesthetics and adjuvants that can be administered for scalp nerve block (SNB) in adult patients undergoing craniotomy. SNBs are an effective means to provide patients with analgesia with lower opioid requirements.</p><p><strong>Recent findings: </strong>Recent literature shows a wide range of neurosurgical procedures can benefit from the administration of scalp blocks. Scalp blocks remain a technically straightforward regional anesthesia technique; however, the literature is insufficient to firmly recommend any specific local anesthetic or adjuvant.</p><p><strong>Summary: </strong>SNBs should be considered a low risk, technically easy to perform, and highly effective regional anesthesia technique in a wide range of neurosurgical procedures. A long-acting local anesthetic such as ropivacaine, bupivacaine, or levobupivacaine is recommended, and the addition of an adjuvant such as dexmedetomidine, clonidine, or dexamethasone has been shown to prolong the duration of the block. Ultrasound may be useful addition to improve block success.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"598-604"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478473","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}
{"title":"Transfusion strategies in neuroanaesthesia and neurocritical care.","authors":"Alessandro Scudellari, Federico Bilotta","doi":"10.1097/ACO.0000000000001523","DOIUrl":"10.1097/ACO.0000000000001523","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"564-568"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","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}
{"title":"The evolving landscape of airway education in anesthesia for head and neck surgery.","authors":"Alexander Fuchs, Vladimir Nekhendzy, Robert Greif","doi":"10.1097/ACO.0000000000001572","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001572","url":null,"abstract":"<p><strong>Purpose of review: </strong>Airway management for head and neck surgery presents some of the most unique and complex challenges for both adult and pediatric patient populations. High level of technical proficiency is essential, and the technical skill set should be complemented by a variety of solid nontechnical skills to ensure adequate interdisciplinary and interprofessional collaboration. Little is known about state-of-the-art teaching methods addressing these important skills.</p><p><strong>Recent findings: </strong>This article explores recent advancements in airway education, focusing on how technical and nontechnical skills could be best integrated into head and neck anesthesia teaching curricula with the goals of optimizing airway management outcomes and patient safety.</p><p><strong>Summary: </strong>We examined the role of simulation-based training, competency-based medical education, and the emphasis on human factors in head and neck anesthesia to facilitate shaping modern curricula.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277046","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}
{"title":"Transformation of patient safety through leadership and organizational alignment.","authors":"Emily Methangkool","doi":"10.1097/ACO.0000000000001576","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001576","url":null,"abstract":"<p><strong>Purpose of review: </strong>Although tremendous progress has been made in patient safety in the past few decades, critical gaps still remain. This review will address how leadership and organizational alignment can help move patient safety forward.</p><p><strong>Recent findings: </strong>Alternative leadership styles may have positive impacts on safety climate, psychological safety, and clinician burnout.</p><p><strong>Summary: </strong>Patient safety in anesthesiology has made tremendous strides since the discovery of anesthesia, but progress over the past few decades has been less visible. Critical gaps and opportunities still remain; leadership and organizational alignment play a key role in making continued improvements in patient safety. Safety efforts may stall due to problems with incident reporting, lack of sufficient resources and training, and clinician burnout. Leadership approaches that focus on transparency, accountability, humility, vulnerability, and a nonpunitive response to error can help improve safety climate and encourage engagement in patient safety work. Leadership should dedicate time and resources to a Patient Safety Committee and a Patient Safety Officer. Finally, proactive leadership that fosters a positive culture of safety is essential to navigating new payment models and reporting structures.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277009","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}
Molly Wilde, Aalok V Agarwala, Brian J Thomas, Karolina Brook
{"title":"Sharing is caring: the importance of transparency in adverse events.","authors":"Molly Wilde, Aalok V Agarwala, Brian J Thomas, Karolina Brook","doi":"10.1097/ACO.0000000000001574","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001574","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides an overview of the concept of transparency, focusing on the various ways that adverse events are shared within and across departments in a single institution, across different institutions, and with national organizations.</p><p><strong>Recent findings: </strong>Within a department, strategies to promote transparency from frontline clinicians to department leadership (bottom-up transparency) include easy-to-use reporting systems and maintaining a robust safety culture. Top-down transparency can be facilitated with the timely sharing of systemic changes made because of reported events and the continued cultivation of a psychologically safe learning environment. Daily safety huddles, leadership walkrounds, and shared case conferences that break down barriers in communication can encourage interdepartmental transparency. Sharing events across institutions remains challenging. In addition, while reporting events to national registries and databases does occur, top-down transparency back to hospitals and departments remains unsystematic. Finally, there exist several legal challenges to advancing transparency.</p><p><strong>Summary: </strong>There has been much progress nationally in enhancing the transparency of adverse events. Future areas of improvement include cross-institutional transparency and facilitating the timely sharing of repeat concerns and lessons learned from national registries back with participating institutions and departments. Concerns about legal consequences when discussing adverse events may prohibit expanded transparency.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277038","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}
George Tewfik, Faraz Chaudhry, Daniel Rodriguez-Correa, Rania Aziz, Rotem Naftalovich
{"title":"Metadata: how data about data affects patient safety in anesthesia.","authors":"George Tewfik, Faraz Chaudhry, Daniel Rodriguez-Correa, Rania Aziz, Rotem Naftalovich","doi":"10.1097/ACO.0000000000001575","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001575","url":null,"abstract":"<p><strong>Purpose of review: </strong>Metadata - data about data - offers powerful opportunities to enhance patient safety in anesthesiology. By analyzing patterns, behaviors, and processes from electronic health records (EHRs), physiologic monitors, and other digital systems, metadata helps clinicians and administrators assess trends, optimize workflows, and identify safety risks. This review explores perioperative metadata sources and highlights real-world applications, including clinical decision support tools, operational dashboards, and EHR analytics. Challenges such as poor data quality, lack of standardization, and risks of misuse for surveillance or punitive purposes are also examined. We discuss how anesthesiologists can use metadata to improve documentation, monitor quality metrics, and detect early signs of deterioration.</p><p><strong>Recent findings: </strong>Metadata from EHRs and monitors is being used to identify practice patterns, enhance documentation, and detect early patient deterioration. Operational dashboards and decision support tools relying on metadata have shown promise for improving safety. Challenges include data overload, documentation variability, and ethical concerns about privacy, surveillance, and clinician accountability.</p><p><strong>Summary: </strong>Metadata provides a framework to classify, interpret, and act on data from countless medical sources. In anesthesiology, it holds significant potential for improving patient safety, though clinicians must understand both its promise and limitations.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277050","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}
{"title":"Anesthesia management in thyroid surgery.","authors":"Stefano Falcetta, Imran Ahmad, Daniele Salvatore Paternò, Massimiliano Sorbello","doi":"10.1097/ACO.0000000000001569","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001569","url":null,"abstract":"<p><strong>Purpose of review: </strong>Thyroid surgery presents unique anesthetic challenges because of the anatomical proximity of the thyroid gland to the airway and critical neurovascular structures. This review highlights the importance of a structured and individualized perioperative approach in the context of increasing surgical volumes and evolving techniques.</p><p><strong>Recent findings: </strong>Preoperative assessment must be meticulous and multileveled, particularly in patients with goiter, tracheal deviation, or obesity. Risk stratification can be improved through advanced tools such as nasendoscopy, airway ultrasound, and neck circumference-to-thyromental distance ratio. Intraoperative management requires careful airway planning, optimized patient positioning, intraoperative nerve monitoring, and hemodynamic stability. Videolaryngoscopy is increasingly favored for its improved visualization and facilitation of electromyographic tube placement. Postoperative complications such as hematoma, tracheomalacia, and hypocalcemia demand structured monitoring. Artificial intelligence shows promise in enhancing prediction and decision-making in airway management.</p><p><strong>Summary: </strong>A context-sensitive, multidisciplinary approach across all perioperative phases is essential to improve safety and outcomes in thyroid surgery. Emphasis on airway assessment, vigilant intraoperative monitoring, and proactive postoperative care should guide clinical practice and future research.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277069","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}
Andreas Creutzburg, Johan Heiberg, Jacob Steinmetz
{"title":"Too old for ambulatory anaesthesia? Management of ambulatory anaesthesia in elderly adults.","authors":"Andreas Creutzburg, Johan Heiberg, Jacob Steinmetz","doi":"10.1097/ACO.0000000000001568","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001568","url":null,"abstract":"<p><strong>Purpose of this review: </strong>As the elderly population continues to grow and their physiological reserves decline, perioperative morbidity and mortality are increasing, consequently. A significant proportion of these patients are frail, which further elevates their risk of postoperative complications and adverse outcomes. At the same time, technological and surgical advancements have expanded the scope of procedures that can be safely performed in ambulatory settings, making it possible for many common surgeries in elderly patients to be conducted on an outpatient basis.</p><p><strong>Recent findings: </strong>Recent studies and guidelines confirm that ambulatory surgery is a safe and effective option for many procedures, including in older adults. Benefits include quicker recovery times and a reduced incidence of perioperative neurocognitive disorders compared with inpatient surgery. However, these advantages rely on thorough preoperative evaluation, particularly in frail elderly patients. Comprehensive assessments, including cognitive, nutritional, and standard anaesthesiologic evaluations, are essential to ensure patient safety and to optimise outcomes.</p><p><strong>Summary: </strong>This review summarises current literature on the management of elderly patients undergoing ambulatory surgery, emphasising the importance of individualised preoperative assessment and patient selection.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277064","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}