Current opinion in anaesthesiology最新文献_第9页

Perioperative management considerations in patients taking prescribed psychoactive medications (including those for depression and Parkinson's disease). 服用处方精神活性药物(包括抑郁症和帕金森病)患者的围手术期管理考虑。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-10-01 DOI: 10.1097/ACO.0000000000001041

Serene Ho, Adrian Wong

{"title":"Perioperative management considerations in patients taking prescribed psychoactive medications (including those for depression and Parkinson's disease).","authors":"Serene Ho, Adrian Wong","doi":"10.1097/ACO.0000000000001041","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001041","url":null,"abstract":"Purpose of review: Given the number of drugs available in the anaesthetist's armamentarium, drug interactions need to be managed. This is particularly true of psychoactive medications which primarily act on the central nervous system, targeting neurotransmitter pathways often affected by anaesthetic agents. This review gives an overview of the potential interactions of commonly used psychoactive medications with anaesthetic agents and hence their perioperative considerations. As anaesthetists will already be very familiar with the benzodiazepines, they will not be discussed here. Electroconvulsive therapy will also not be discussed.Recent findings: A wide range of psychoactive medications can interact with drugs commonly used in perioperative care including anaesthetic agents. There is limited clinical research into their effects and hence these interactions are based on known pharmacological actions.Summary: A cautious, pragmatic approach is recommended when managing patients on psychoactive medications requiring anaesthesia as part of their medical care.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"582-589"},"PeriodicalIF":2.5,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345323","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: 2

New ultrasound-guided techniques in chronic pain management: an update. 新的超声引导技术在慢性疼痛管理:更新。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-10-01 DOI: 10.1097/ACO.0000000000001037

Tolga Ergönenç, Janneken Stockman

{"title":"New ultrasound-guided techniques in chronic pain management: an update.","authors":"Tolga Ergönenç, Janneken Stockman","doi":"10.1097/ACO.0000000000001037","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001037","url":null,"abstract":"Purpose of review: The introduction of ultrasound guidance in interventional pain management leads to the development of new interventional pain management techniques. Ultrasound-guided (UG) interventional pain management is rapidly developing and increasingly more commonly used, due to its many advantages over traditional radiologic imaging modalities. This review will summarize recent literature around novel interventional pain techniques with ultrasound guidance published over the last 18 months.Recent findings: Many new interventional pain management methods have been described in the last few years in the literature. The use of ultrasonography in interventional pain management played a crucial role in these developments. This review includes newly described interventional methods in the literature. The review particularly focussed on the methods that are used to treat the pain in the hip, shoulder, knee, and lumbar area. These new techniques hold promise for significant improvements in the efficacy and safety of interventional pain management.Summary: There have been many innovations in UG interventional procedures, however, some of them require more rigorous validation before their widespread use.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"634-640"},"PeriodicalIF":2.5,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345325","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: 3

Anesthesia and intraoperative neurophysiological spinal cord monitoring. 麻醉与术中脊髓神经生理监测。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-10-01 DOI: 10.1097/ACO.0000000000001044

Marko M Sahinovic, Maria C Gadella, Jay Shils, Sebastiaan E Dulfer, Gea Drost

{"title":"Anesthesia and intraoperative neurophysiological spinal cord monitoring.","authors":"Marko M Sahinovic, Maria C Gadella, Jay Shils, Sebastiaan E Dulfer, Gea Drost","doi":"10.1097/ACO.0000000000001044","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001044","url":null,"abstract":"Purpose of review: We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery.Recent findings: In recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist.Summary: Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"590-596"},"PeriodicalIF":2.5,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39345324","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: 13

Severe bleeding in the ICU. 重症监护室大出血。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001019

Marcel J Rauer, Vanessa Neef, Lorenzo Berra

{"title":"Severe bleeding in the ICU.","authors":"Marcel J Rauer, Vanessa Neef, Lorenzo Berra","doi":"10.1097/ACO.0000000000001019","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001019","url":null,"abstract":"Purpose of review: Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only.Recent findings: Recent publications generally support previous studies that a strict transfusion regimen is superior to a liberal one for the majority of cases. Newly developed and easily feasible techniques are currently in clinical trials and have the potential to become a valuable supplementation to hemoglobin-guided decision-making. In addition to the choice of the ideal transfusion strategy, physiological status and comorbidities were found to have a major impact on the outcome of severe bleedings in the ICU.Summary: The body of evidence for ICU-specific transfusion guidelines is scarce. Critical care physicians should properly evaluate their patient's comorbidities and consider extended point-of-care testing for transfusion decisions in indistinct anemic situations. A strict transfusion strategy should, however, be applied whenever possible.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"530-536"},"PeriodicalIF":2.5,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39020375","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: 1

Moderate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice. 中度和深度程序性镇静——适当的监测和安全技术在临床实践中的作用。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001011

Joseph E Manzi, Mark R Jones, Elyse M Cornett, Alan D Kaye

{"title":"Moderate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice.","authors":"Joseph E Manzi, Mark R Jones, Elyse M Cornett, Alan D Kaye","doi":"10.1097/ACO.0000000000001011","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001011","url":null,"abstract":"Purpose of review: Interventional pain management procedures provide significant improvement to patient quality of life and functionality. In-office procedures are becoming an increasingly more common site of pain management intervention for patients with minimal risk of harm.Recent findings: Moderate and deep sedation techniques can be used in patients with high anxiety, complex pharmacotherapy, or a low pain threshold. Proper guidance and oversight by an attending anesthesiologist, in addition to appropriate monitoring, are key. Epidural steroid injection complications rates have been cited at 2.4%, with the most common complications noted as persistent pain and flushing.Summary: Serious complication errors can be avoided with proper supervision and monitoring. The adherence to published societal recommendations and guidelines for indications of when to use moderate to deep sedation techniques, and appropriate supervision and monitoring methods, can avoid errors in interventional pain management procedures.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"497-501"},"PeriodicalIF":2.5,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39020376","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: 2

Selective periarticular blocks for postoperative pain after hip and knee arthroplasty. 选择性关节周围阻滞治疗髋关节和膝关节置换术后疼痛。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000000943

Angela Lucia Balocco, Eveline Claes, Ana Lopez, Imré Van Herreweghe

引用次数: 4

Prehospital administration of blood and plasma products. 院前血液和血浆制品的管理。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001028

Anna Roehl, Oliver Grottke

引用次数: 3

Editorial: Challenges of the pandemics for trauma and transfusion management as well as state-of-the-art reviews. 社论:流行病对创伤和输血管理的挑战以及最新的审查。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001030

Andrea U Steinbicker

引用次数: 0

Fibrinogen in traumatic haemorrhage. 外伤性出血中的纤维蛋白原。

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001027

James Winearls, Michael C Reade, Zoe McQuilten, Nicola Curry

{"title":"Fibrinogen in traumatic haemorrhage.","authors":"James Winearls, Michael C Reade, Zoe McQuilten, Nicola Curry","doi":"10.1097/ACO.0000000000001027","DOIUrl":"10.1097/ACO.0000000000001027","url":null,"abstract":"Purpose of review: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy (TIC) have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the role of fibrinogen in normal haemostasis, the effect of trauma and TIC on fibrinogen levels and current evidence for fibrinogen replacement in the management of traumatic haemorrhage.Recent findings: Fibrinogen is usually the first factor to reach critically low levels in traumatic haemorrhage and hypofibrinogenaemia after severe trauma is associated with increased risk of massive transfusion and death. It is postulated that the early replacement of fibrinogen in severely injured trauma patients can improve outcomes. There is, however, a paucity of evidence to support this, and in addition, there is little evidence to support or refute the effects of cryoprecipitate or fibrinogen concentrate for fibrinogen replacement.Summary: The important role fibrinogen plays in haemostasis and effective clot formation is clear. A number of pilot trials have investigated different strategies for fibrinogen replacement in severe trauma. These trials have formed the basis of several large-scale phase III trials, which, cumulatively will provide a firm evidence base to harmonise worldwide clinical management of severely injured trauma patients with major haemorrhage.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"514-520"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39063686","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

Inhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation. 吸入麻醉剂、臭氧损耗和温室变暖:我们在环境减缓方面的努力的基础和现状。

IF 2.5

Current opinion in anaesthesiology Pub Date : 2021-08-01 DOI: 10.1097/ACO.0000000000001009

Rita Lopes, Cliff Shelton, Mike Charlesworth

{"title":"Inhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation.","authors":"Rita Lopes, Cliff Shelton, Mike Charlesworth","doi":"10.1097/ACO.0000000000001009","DOIUrl":"https://doi.org/10.1097/ACO.0000000000001009","url":null,"abstract":"Purpose of review: Following their use for medicinal purposes, volatile inhalational anaesthetic agents are expelled into the atmosphere where they contribute to anthropogenic climate change. We describe recent evidence examining the benefits and harms associated with their use.Recent findings: The environmental harms associated with desflurane and nitrous oxide likely outweigh any purported clinical benefits. Life cycle analyses are beginning to address the many gaps in our understanding, and informing choices made on all aspects of anaesthetic care. There is, however, an urgent need to move beyond the debate about anaesthetic technique A vs. B and focus also on areas such as sustainable procurement, waste management, pharmacological stewardship and joined-up solutions.Summary: There is now compelling evidence that anaesthetists, departments and hospitals should avoid desflurane completely, and limit nitrous oxide use to settings where there is no viable alternative, as their environmental harms outweigh any perceived clinical benefit. Life cycle analyses seem supportive of total intravenous and/or regional anaesthesia. There are many other areas where choices can be made by individual anaesthetists that contribute towards reducing the environmental burden of healthcare, such as prioritising the reduction of inappropriate resource use and over-treatment. However, this all requires joined up solutions where all parts of an organisation engage.","PeriodicalId":520600,"journal":{"name":"Current opinion in anaesthesiology","volume":" ","pages":"415-420"},"PeriodicalIF":2.5,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38958011","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: 4