Current opinion in anaesthesiology最新文献

{"title":"Neurological monitoring in liver transplantation: innovative approaches and perioperative strategies for managing brain complications.","authors":"Luca Cremascoli, Antonio Toscano, Filippo Castelli, Antonio Voza, Raymond Planinsic","doi":"10.1097/ACO.0000000000001511","DOIUrl":"10.1097/ACO.0000000000001511","url":null,"abstract":"<p><strong>Purpose of review: </strong>Neurologic disorders in acute and chronic liver disease present a significant challenge in the perioperative management of patients undergoing liver transplantation. Neurologic examination is often limited in comatose or sedated patients, so instrumental monitoring of brain function is essential for prompt diagnosis and management of conditions that could cause brain injury. The purpose of this review is to summarize recent findings and provide an outlook for future developments.</p><p><strong>Recent findings: </strong>Encephalopathic patients undergoing liver transplantation are at risk of developing brain injury and neurological complications before, during, and after the procedure. Noninvasive brain monitoring systems, compared with invasive ones, have been recently investigated and applied during the perioperative period of liver transplantation. Perioperative evaluation of cerebral autoregulation derangements can guide optimization of cerebral perfusion pressure, thereby avoiding the risks of ischemia and brain edema. Ultrasound measurement of the optic nerve sheath diameter can help exclude the presence of intracranial hypertension, a frequent and dangerous consequence of acute liver failure. The application of automated quantitative pupillometry in liver failure patients allows for a more precise evaluation of the severity of brain injury. Quantitative electroencephalography monitoring, along with portable instruments, facilitates easier identification and monitoring of perioperative seizures.</p><p><strong>Summary: </strong>Neurological monitoring in liver transplantation is crucial for the early detection and management of neurological complications that may arise due to metabolic disturbances, acute liver failure, or the effects of immunosuppressive medications. Timely monitoring allows for optimal patient management, reducing the risk of permanent neurological damage and improving overall transplant outcomes.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"457-464"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259870","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":"'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":"<p><strong>Purpose of review: </strong>The aim is to summarize perioperative management of patients with acute liver failure (ALF).</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"503-512"},"PeriodicalIF":2.1,"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}

{"title":"Portopulmonary hypertension: diagnosis and preoperative management.","authors":"David W Wang, Akira Katayama, Marianne M Ligon, Ezeldeen Abuelkasem","doi":"10.1097/ACO.0000000000001527","DOIUrl":"10.1097/ACO.0000000000001527","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 4","pages":"445-451"},"PeriodicalIF":2.1,"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}

{"title":"Outcomes in ambulatory surgery.","authors":"Conrad S Myler, Robert Kerris, Niraja Rajan","doi":"10.1097/ACO.0000000000001554","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001554","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines current economic and patient safety outcomes in ambulatory surgery. With the anticipated explosive growth of procedures performed in ambulatory surgery centers (ASCs) and office-based settings, this review is timely and relevant.</p><p><strong>Recent findings: </strong>Ambulatory surgery volume continues to grow consistently, with 19.2 million ambulatory surgeries performed in US community hospitals in 2018. It is projected that between 2024 and 2034, ASC volume will rise 21% to 44 million procedures annually. The cost of performing the same procedure at an ASC or office-based setting is significantly lower compared to hospital outpatient departments with no difference in patient safety outcomes. Our profession is in the early stages of developing machine learning models, which will allow us to develop case-specific selection criteria and improve our ability to identify which patients can safely undergo more complex surgeries at ASCs.</p><p><strong>Summary: </strong>As the complexity and diversity of patients, procedures, and facilities increase, it is increasingly evident that our prior universal selection criteria will need to be replaced with more nuanced criteria. It remains to be determined how the introduction of other technologies, such as outpatient wearable devices and remote monitoring, will impact the patient or procedural complexity that can be safely accommodated. Patient-reported outcome measures allow identification of minor adverse events, which are more common in the ambulatory setting.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786410","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 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":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","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}

{"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":"<p><strong>Purpose of the review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","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}

{"title":"Pediatric obstructive sleep-disordered breathing and anesthetic considerations.","authors":"Yaqi Hu, Samantha Smith, Alice T Coombs","doi":"10.1097/ACO.0000000000001482","DOIUrl":"10.1097/ACO.0000000000001482","url":null,"abstract":"<p><strong>Purpose of the review: </strong>The purpose of the review is to evaluate pathophysiology of pediatric obstructive sleep-disordered breathing (oSDB), its anesthetic implications, and recommendations for perioperative care.</p><p><strong>Recent finding: </strong>Pediatric patients with oSDB develop neurocognitive consequences and are at increased risk for perioperative complications.</p><p><strong>Summary: </strong>To minimize the incidence of perioperative adverse events for pediatric patients with oSDB, anesthesia providers must have a thorough understanding of the pathophysiology of the disease and be up to date on current recommendations when caring for these patients.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 3","pages":"272-277"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328375","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":"Editorial.","authors":"Dolores B Njoku","doi":"10.1097/ACO.0000000000001503","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001503","url":null,"abstract":"","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 3","pages":"215-216"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328349","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 changing landscape of anesthetic practice, in the operating room and beyond.","authors":"Omonele Nwokolo, Philipp Lirk","doi":"10.1097/ACO.0000000000001500","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001500","url":null,"abstract":"","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"38 3","pages":"278-280"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328376","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":"Introduction to exchange between Anderson and Kampman and Weiland.","authors":"Edoardo De Robertis","doi":"10.1097/ACO.0000000000001380","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001380","url":null,"abstract":"","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":"37 4","pages":"427"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201353","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}