Current opinion in anaesthesiology最新文献

{"title":"Ethical dilemmas in anesthesia mission trips.","authors":"Nicole C P Thompson,&nbsp;Zachary Weinerman,&nbsp;Jasmine Solola","doi":"10.1097/ACO.0000000000000962","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000962","url":null,"abstract":"<p><strong>Purpose of review: </strong>Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips.</p><p><strong>Recent findings: </strong>Physician volunteers for medical missions may cause significant harm to patients and host communities if they do not work in tandem with host institutions.</p><p><strong>Summary: </strong>Medical missions fulfill acute medical needs and have the opportunity to make a positive contribution to host communities by fulfilling local needs and supporting educational efforts for local providers.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"137-140"},"PeriodicalIF":2.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25348393","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":"Septic shock: a microcirculation disease.","authors":"Daniel De Backer,&nbsp;Francesco Ricottilli,&nbsp;Gustavo A Ospina-Tascón","doi":"10.1097/ACO.0000000000000957","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000957","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to discuss the implication of microvascular dysfunction in septic shock.</p><p><strong>Recent findings: </strong>Resuscitation of sepsis has focused on systemic haemodynamics and, more recently, on peripheral perfusion indices. However, central microvascular perfusion is altered in sepsis and these alterations often persist despite normalization of various macro haemodynamic resuscitative goals. Endothelial dysfunction is a key element in sepsis pathophysiology. It is responsible for the sepsis-induced hypotension. In addition, endothelial dysfunction is also implicated involved in the activation of inflammation and coagulation processes leading to amplification of the septic response and development of organ dysfunction. It also promotes an increase in permeability, mostly at venular side, and impairs microvascular perfusion and hence tissue oxygenation.Microvascular alterations are characterized by heterogeneity in blood flow distribution, with adequately perfused areas in close vicinity to not perfused areas, thus characterizing the distributive nature of septic shock. Such microvascular alterations have profound implications, as these are associated with organ dysfunction and unfavourable outcomes. Also, the response to therapy is highly variable and cannot be predicted by systemic hemodynamic assessment and hence cannot be detected by classical haemodynamic tools.</p><p><strong>Summary: </strong>Microcirculation is a key element in the pathophysiology of sepsis. Even if microcirculation-targeted therapy is not yet ready for the prime time, understanding the processes implicated in microvascular dysfunction is important to prevent chasing systemic hemodynamic variables when this does not contribute to improve tissue perfusion.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"85-91"},"PeriodicalIF":2.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25362278","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":"Gender pay disparity in anesthesiology.","authors":"Yaqi Hu,&nbsp;Deanna Couser","doi":"10.1097/ACO.0000000000000972","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000972","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to look at the historical and current gender pay gap in healthcare, specifically in the field of anesthesiology, as well as discuss some of the reasons for the difference in compensation and its consequences. Future aims and directions to bridge the gap will also be explored.</p><p><strong>Recent findings: </strong>Even though women have achieved equality in terms of admission to medical school and residency programs, disparities still exist in terms of compensation for equal or comparable work. However, institutional initiatives to close the pay gap have achieved success.</p><p><strong>Summary: </strong>In order to improve the gender pay inequality, there needs to be continuous efforts on the institutional level for recognition of the disparity, initiation of programs for mentorship and sponsorship for female faculties, and continuous monitoring of the effect of the programs.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"145-148"},"PeriodicalIF":2.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25389640","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":"Does thoracic epidural anaesthesia constitute over-instrumentation in video- and robotic-assisted thoracoscopic lung parenchyma resections?","authors":"Torsten Loop","doi":"10.1097/ACO.0000000000000975","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000975","url":null,"abstract":"<p><strong>Purpose of review: </strong>Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way.</p><p><strong>Recent findings: </strong>Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pneumonia and other postoperative pulmonary complications.In addition, inadequate pain therapy after these procedures may lead to chronic pain.</p><p><strong>Summary: </strong>Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"199-203"},"PeriodicalIF":2.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25404908","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":"Acute respiratory failure and burn patient outcomes.","authors":"Rami Maarouf,&nbsp;Cedric Campbell","doi":"10.1097/ACO.0000000000000973","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000973","url":null,"abstract":"<p><strong>Purpose of review: </strong>Advances in the care of inhalational injuries have not kept pace with advances that have been seen in the treatment of cutaneous burns. There is not yet a standard of care for best outcomes for airway management of patients with known or suspected inhalational injuries. Clinicians must decide if to intubate the patient, and if so, whether to intubate early or late in their presentation. Unnecessary intubation affects morbidity and mortality. This review will summarize literature that highlights present practices in the treatment of patients with inhalation injuries.</p><p><strong>Recent findings: </strong>There have been promising investigations into biomarkers that can be used to quantify a patient's risk and better target therapies. Grading systems serve to better stratify the burn victim's prognosis and then direct their care. Special ventilator modes can assist in ventilating burn patients with inhalation injuries that experience difficulties in oxygenating.</p><p><strong>Summary: </strong>Inhalational injuries are a significant source of morbidity and mortality in thermally injured patients. Treatment modalities, such as modified ventilator settings, alteration in fluid resuscitation, and a standardized grading system may improve morbidity and mortality.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"180-186"},"PeriodicalIF":2.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25389641","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":"Epidemiology of sepsis and septic shock.","authors":"Catherine Chiu,&nbsp;Matthieu Legrand","doi":"10.1097/ACO.0000000000000958","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000958","url":null,"abstract":"<p><strong>Purpose of review: </strong>The epidemiology of sepsis and septic shock has been challenging to study for multiple reasons. These include changing diagnostic definitions, as well a high concentration of sepsis-related studies published from high-income countries (HICs), despite a large global burden. This section attempts to address the incidence of sepsis throughout the years and worldwide.</p><p><strong>Recent findings: </strong>The incidence of sepsis and septic shock has continued to increase since the first consensus definitions (Sepsis-1) were established in 1991, and the latest definitions (Sepsis-3) provide a better reflection of mortality risk for a diagnosis of sepsis. Several studies argue that the incidence of sepsis is overreported in HICs, based on billing and coding practices, and may lead to overutilization of resources. However, recent estimates of the true global burden of sepsis, including low-income countries, are likely much higher than reported, with calls for better allocation of resources.</p><p><strong>Summary: </strong>The true epidemiology of sepsis worldwide continues to be a highly debated subject, and more research is needed among low-income countries and high-risk subpopulations.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"71-76"},"PeriodicalIF":2.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38792003","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":"Postoperative delirium - treatment and prevention.","authors":"Thomas Duning,&nbsp;Katharina Ilting-Reuke,&nbsp;Mara Beckhuis,&nbsp;Daniel Oswald","doi":"10.1097/ACO.0000000000000939","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000939","url":null,"abstract":"<p><strong>Purpose of review: </strong>Postoperative delirium (POD) is one of the most severe complications after surgery.The consequences are dramatic: longer hospitalization, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life. Actually, no global guideline with standardized concepts of management exists. Advances in prevention, diagnosis and treatment can improve recognition and risk stratification of delirium and its consequences.</p><p><strong>Recent findings: </strong>Management of POD is a multiprofessional approach and consists of different parts: First, the detection of high-risk patients with a validated tool, preventive nonpharmacological concepts and an intraoperative anesthetic management plan that is individualized to the older patient (e.g. avoiding large swings in blood pressure, vigilance in maintaining normothermia, ensuring adequate analgesia and monitoring of anesthetic depth). In addition to preventive standards, treatment and diagnostic concepts must also be available, both pharmaceutical and nonpharmacological.</p><p><strong>Summary: </strong>Not every POD can be prevented. It is important to detect patients with high risk for POD and have standardized concepts of management. The most important predisposing risk factors are a higher age, preexisting cognitive deficits, multimorbidity and an associated prodelirious polypharmacy. In view of demographic change, the implementation of multidisciplinary approaches to pharmacological and nonpharmacological POD management is highly recommended.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"27-32"},"PeriodicalIF":2.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38369652","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: Anesthesia for the older surgical patient: beyond standard care?","authors":"Leanne Groban","doi":"10.1097/ACO.0000000000000948","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000948","url":null,"abstract":"DOI:10.1097/ACO.0000000000000948 By the year 2024 people 65 years and older will represent over a quarter of the global population. Soon, we will have more older people than children and more peopleat theextremesof old age than ever before. This trend in population ageing will undoubtedly translate into increasing numbers of older adults in developed countries requiring invasive and minimally invasive procedures for revascularization-related, joint repair and replacement-related, urologic and gynecologicrelated, gastrointestinal-related and ophthalmologicrelated surgeries, and more. One of the major challenges of treating older patients is the heterogeneity of the geriatric population – and the need to individualize care for each patient to provide the best outcome. Indeed, the incidence of comorbidity increases with age, so does the risk for postoperative complications which further underscores the central role anesthesiologists are certain to play, moving forward as gerontological-perioperativists in the care of the older surgical patient. Having instinctual perceptiveness and exceptional procedural skills ranging from preoperative preparation, intraoperative anesthetic management, and postoperative pain management to intensive care, anesthesiologists are well suited to ensure consistent, coordinated, and integrated care throughout the entire perioperative period of these patientsso theycanreturn toanoptimalqualityof life. The current concept is very near and dear to my heart having recently moved my 87-year-old mother and her 90-year-old husband to my city and integrating them into multi and interdisciplinary medical management teams, and coordinating same-day surgery care, to help them to continue to thrive independently. To this end, having a thorough understanding of the needs, complications, and physiologic changes in the older patient requires continuing education in topics surrounding geriatric perioperative medicine. This series in CurrentOpinions inAnesthesiology will, I hope, offer a platform for that. We start with an up-to-date review by Einav et al. [1] of findings from across the globe on in and out of hospital cardiac arrest and outcomes of older adults. While older age does not justify withholding cardiopulmonary resuscitation, these authors stress the importance of a shared decision-making process","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"25-26"},"PeriodicalIF":2.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38684754","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":"Minimizing postoperative pulmonary complications in thoracic surgery patients.","authors":"Kai Kaufmann,&nbsp;Sebastian Heinrich","doi":"10.1097/ACO.0000000000000945","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000945","url":null,"abstract":"<p><strong>Purpose of review: </strong>Quantification and optimization of perioperative risk factors focusing on anesthesia-related strategies to reduce postoperative pulmonary complications (PPCs) after lung and esophageal surgery.</p><p><strong>Recent findings: </strong>There is an increasing amount of multimorbid patients undergoing thoracic surgery due to the demographic development and medical progress in perioperative medicine. Nevertheless, the rate of PPCs after thoracic surgery is still up to 30-50% with a significant influence on patients' outcome. PPCs are ranked first among the leading causes of early mortality after thoracic surgery. Although patients' risk factors are usually barely modifiable, current research focuses on procedural risk factors. From the surgical position, the minimal-invasive approach using video-assisted thoracoscopy and laparoscopy leads to a decreased rate of PPCs. The anesthesiological strategy to reduce the incidence of PPCs after thoracic surgery includes neuroaxial anesthesia, lung-protective ventilation, and goal-directed hemodynamic therapy.</p><p><strong>Summary: </strong>The main anesthesiological strategies to reduce PPCs after thoracic surgery include the use of epidural anesthesia, lung-protective ventilation: PEEP (positive end-expiratory pressure) of 5-8 mbar, tidal volume of 5 ml/kg BW (body weight) and goal-directed hemodynamics: CI (cardiac index) ≥ 2.5 l/min per m2, MAD (Mean arterial pressure) ≥ 70 mmHg, SVV (stroke volume variation) < 10% with a total amount of perioperative crystalloid fluids ≤ 6 ml/kg BW (body weight) per hour.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"13-19"},"PeriodicalIF":2.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38369653","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":"Prevent deterioration and long-term ventilation: intensive care following thoracic surgery.","authors":"Johannes Kalbhenn","doi":"10.1097/ACO.0000000000000944","DOIUrl":"https://doi.org/10.1097/ACO.0000000000000944","url":null,"abstract":"<p><strong>Purpose of review: </strong>Patients with indication for lung surgery besides the pulmonary pathology often suffer from independent comorbidities affecting several other organ systems. Preventing patients from harmful complications due to decompensation of underlying organ insufficiencies perioperatively is pivotal. This review draws attention to the peri- and postoperative responsibility of the anaesthetist and intensivist to prevent patients undergoing lung surgery deterioration.</p><p><strong>Recent findings: </strong>During the last decades we had to accept that 'traditional' intensive care medicine implying deep sedation, controlled ventilation, liberal fluid therapy, and broad-spectrum antimicrobial therapy because of several side-effects resulted in prolongation of hospital length of stay and a decline in quality of life. Modern therapy therefore should focus on the convalescence of the patient and earliest possible reintegration in the 'life-before.' Avoidance of sedative and anticholinergic drugs, early extubation, prophylactic noninvasive ventilation and high-flow nasal oxygen therapy, early mobilization, well-adjusted fluid balance and reasonable use of antibiotics are the keystones of success.</p><p><strong>Summary: </strong>A perioperative interprofessional approach and a change in paradigms are the prerequisites to improve outcome and provide treatment for elder and comorbid patients with an indication for thoracic surgery.</p>","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"20-24"},"PeriodicalIF":2.5,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38719869","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}