Current opinion in anaesthesiology最新文献_第6页

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

IF 2.1

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":2.1,"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

The role of veno-venous bypass in liver transplant. 静脉-静脉旁路在肝移植中的作用。

IF 2.1

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":2.1,"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

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。

IF 2.1

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。

IF 2.1

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":2.1,"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

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。

IF 2.1

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":"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":2.1,"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。

IF 2.1

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":"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":2.1,"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

Anesthesia and liver transplantation: pathophysiological and therapeutic lessons from history. 麻醉和肝移植：病理生理和治疗的历史教训。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/ACO.0000000000001514

Christian Zanza, Raymond M Planinsic, Yaroslava Longhitano

引用次数: 0

Interdisciplinary in situ simulation in non-operating room anesthesia. 非手术室内麻醉的跨学科原位模拟。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-05-13 DOI: 10.1097/ACO.0000000000001517

Anastasia P Piersa, A Taylor Thomas, Rafael Vazquez

{"title":"Interdisciplinary in situ simulation in non-operating room anesthesia.","authors":"Anastasia P Piersa, A Taylor Thomas, Rafael Vazquez","doi":"10.1097/ACO.0000000000001517","DOIUrl":"10.1097/ACO.0000000000001517","url":null,"abstract":"Purpose of review: While the demand for non-operating room anesthesia (NORA) care expands, anesthetic care in NORA settings continues to be associated with unique challenges and hazards. Simulation has been recommended as an effective patient safety tool promoting interprofessional communication and crisis response in this setting. The aim of this review is to examine the current literature on simulation in NORA, focusing specifically on interprofessional in situ simulation (ISS).Recent findings: ISS is best practiced in an interprofessional setting and involves simulation of clinical scenarios in the environment where clinical care is delivered. Several recent studies across NORA settings have investigated the impact of interprofessional ISS on team dynamics. These studies have concluded that the implementation of ISS improves patient safety and is associated with improvement in interprofessional communication, understanding of team members' roles, and coordination during crisis management. Most studies to date have focused on qualitative analysis of simulation participant experiences.Summary: Interprofessional ISS represents a promising strategy to address the unique challenges and hazards faced in NORA settings. Future research on this topic is needed, with a focus on the sustainability and scalability of interprofessional ISS programs and their impact on long-term provider learning and patient outcomes.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"404-408"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268415","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

Perioperative cardiovascular assessment and management of liver transplant patients. 肝移植患者围手术期心血管评估与管理。

IF 2.1

Current opinion in anaesthesiology Pub Date : 2025-08-01 Epub Date: 2025-06-16 DOI: 10.1097/ACO.0000000000001509

Ali O Ibrahim, Mohamed Salah Mohamed, Valentyna Ivanova

{"title":"Perioperative cardiovascular assessment and management of liver transplant patients.","authors":"Ali O Ibrahim, Mohamed Salah Mohamed, Valentyna Ivanova","doi":"10.1097/ACO.0000000000001509","DOIUrl":"10.1097/ACO.0000000000001509","url":null,"abstract":"Purpose of review: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in patients with end-stage liver disease (ESLD), particularly in the perioperative and posttransplant periods. Despite its critical impact, cardiovascular risk assessment and management strategies remain inconsistent across institutions. This review provides a timely synthesis of recent findings, highlighting the need for standardized cardiovascular evaluation and optimization in ESLD patients undergoing liver transplantation (LT).Recent findings: Emerging data emphasize the interplay between cirrhosis, portal hypertension, systemic inflammation, and cardiovascular dysfunction, contributing to cirrhotic cardiomyopathy, coronary artery disease, arrhythmias, and heart failure. Advances in pretransplant screening suggest a shift toward risk-stratified approaches, integrating noninvasive imaging and selective coronary angiography. Intraoperative and postoperative cardiovascular complications remain prevalent, with immunosuppressive therapy exacerbating long-term CVD risk.Summary: A multidisciplinary approach to cardiovascular management in ESLD patients is essential to improving LT outcomes. Standardized preoperative protocols, refined risk stratification, and evidence-based postoperative monitoring are critical to reducing CVD-related complications. Future research should focus on optimizing cardiovascular interventions, developing consensus guidelines, and improving long-term cardiovascular care in LT recipients.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"498-502"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311199","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

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。

IF 2.1

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":"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":2.1,"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