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Current Opinion in Anaesthesiology

Marc Van de Velde
PURPOSE OF REVIEW: Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. RECENT FINDINGS: Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension...
February 8, 2019: Current Opinion in Anaesthesiology
Marek Brzezinski, Jasleen Kukreja, John D Mitchell
PURPOSE OF REVIEW: Teaching in the stressful, high-acuity environment of the ICU is challenging. The intensivist-educator must use teaching strategies that are both effective and time-efficient, as well as evidence-based approaches to the ICU curriculum. This review provides an overview of pertinent educational theories and their implications on educational practices, a selection of effective teaching techniques, and a review on feedback. RECENT FINDINGS: Evidence supports the role of conceptual frameworks in providing the educator with a key perspective to obtain a deeper understanding of the factors contributing to an effective and goal-directed education in the ICU...
February 8, 2019: Current Opinion in Anaesthesiology
Marek Brzezinski
No abstract text is available yet for this article.
February 5, 2019: Current Opinion in Anaesthesiology
Mark E Nunnally, Arpit Patel
PURPOSE OF REVIEW: Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics. RECENT FINDINGS: Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation...
January 31, 2019: Current Opinion in Anaesthesiology
Christian D Becker, Mario V Fusaro, Corey Scurlock
PURPOSE OF REVIEW: The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. RECENT FINDINGS: Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistics and care standardization functions are embedded to optimize ICU bed utilization and reduce complications...
January 28, 2019: Current Opinion in Anaesthesiology
Lori Delaney, Edward Litton, Frank Van Haren
PURPOSE OF REVIEW: Excessive noise has direct adverse physiological and psychological effects, and may also have indirect negative health consequences by reducing sleep quality and quantity. This review presents a synthesis of the epidemiology of noise in the ICU, and the potential interventions designed to attenuate noise and protect patients. RECENT FINDINGS: Noise increases cortisol release, oxygen consumption, and vasoconstriction. ICU noise levels are excessive throughout the 24-h cycle, irrespective of level of intervention or whether the patient is in a side room or open ward...
January 28, 2019: Current Opinion in Anaesthesiology
Corey Scher, Robert Mansky
PURPOSE OF REVIEW: To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. RECENT FINDINGS: Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems...
January 28, 2019: Current Opinion in Anaesthesiology
Jan Gunst, Astrid De Bruyn, Greet Van den Berghe
PURPOSE OF REVIEW: Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. RECENT FINDINGS: Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm...
January 28, 2019: Current Opinion in Anaesthesiology
Jean-Pierre Frat, Florent Joly, Arnaud W Thille
PURPOSE OF REVIEW: High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. RECENT FINDINGS: Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury...
January 28, 2019: Current Opinion in Anaesthesiology
Tina L Palmieri
PURPOSE OF REVIEW: Blood transfusion is ubiquitous in major burn injury. The present article describes recent research findings directly impacting blood transfusion strategies in major burn injury both in the operating room and the ICU. RECENT FINDINGS: Transfusion strategies have been the focus of recent burn investigations. First, a randomized prospective trial encompassing both the ICU and operating room reported that a restrictive red blood cell transfusion threshold (7 g/dl) had equivalent outcomes to a traditional threshold (10 g/dl) for burns more than 20% in terms of mortality, infection, length of stay, duration of mechanical ventilation, and wound healing despite receiving significantly fewer transfusions...
January 22, 2019: Current Opinion in Anaesthesiology
Keith J Ruskin
PURPOSE OF REVIEW: Helicopter air ambulances are an integral component of modern trauma care, and are able to transport patients to facilities with greater capabilities, extract injured patients from hostile terrain, and speed transport to a trauma center. RECENT FINDINGS: HAA transport does not reduce the total time required to transport a patient, but it does reduce the time that the patient is between healthcare facilities. Factors that have been suggested to improve outcomes for trauma patients include the availability of advanced interventions, skilled personnel, speed, and trauma center access...
January 22, 2019: Current Opinion in Anaesthesiology
Junaid Nizamuddin, Avery Tung
PURPOSE OF REVIEW: Many hospitals, particularly large academic centers, have begun to provide 24-h in-house intensive care attending coverage. Proposed advantages for this model include improved patient care, greater provider, nursing and patient satisfaction, better communication, and greater cost-effectiveness. This review will evaluate current evidence with respect to 24/7 coverage, including patient outcomes, cost-effectiveness, and impact on training/education. RECENT FINDINGS: Evidence surrounding 24-h intensivist staffing has been mixed...
January 22, 2019: Current Opinion in Anaesthesiology
Martin Kulla, Erik Popp, Jürgen Knapp
PURPOSE OF REVIEW: Hemorrhage is the major cause of early death in severely injured patients. In civilian emergency medical services, the majority of life-threatening bleedings are found in noncompressible body regions (e.g. abdomen and pelvis). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has therefore been discussed in recent years as a possible lifesaving procedure and numerous studies, meta-analyses and guidelines have been published. In this review, the data situation of REBOA in the management of bleeding trauma patients is discussed and practical implementation is depicted...
January 21, 2019: Current Opinion in Anaesthesiology
Rita Maria Peralta, Pratima Chowdary
PURPOSE OF REVIEW: Uncontrolled bleeding in trauma secondary to a combination of surgical bleeding and trauma-induced complex coagulopathy is a leading cause of death. Prothrombin complex concentrates (PCCs), recombinant activated factor seven (rFVIIa) and recombinant human prothrombin act as procoagulants by increasing thrombin generation and fibrinogen concentrate aids stable clot formation. This review summarizes current evidence for procoagulant use in the management of bleeding in trauma, and data and evidence gaps for routine clinical use...
January 11, 2019: Current Opinion in Anaesthesiology
Anna Clebone
PURPOSE OF REVIEW: Although the overall safety of blood transfusion is high, adverse events do still occur. Much research on transfusion reactions was done in nonperioperative patients. Fortunately, important contributions to the perioperative literature have been made in the last several years, specifically in the areas of transfusion-associated circulatory overload and transfusion-related acute lung injury (TRALI). RECENT FINDINGS: An unfavorable reaction occurs in as many as 1% of transfusions overall, although the risk of death with each unit given is between 0...
January 7, 2019: Current Opinion in Anaesthesiology
Valentina Della Torre, Chiara Robba, Paolo Pelosi, Federico Bilotta
PURPOSE OF REVIEW: The purpose of this review is to describe recent evidence regarding the use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for severe cardiac or respiratory failure in patients with trauma. The characteristics of this cohort of patients, including the risk of bleeding and the need for systemic anticoagulation, are generally considered as relative contraindications to ECMO treatment. However, recent evidence suggests that the use of ECMO should be taken in consideration even in this group of patients...
January 2, 2019: Current Opinion in Anaesthesiology
Benedikt Treml, Elgar Oswald, Bettina Schenk
PURPOSE OF REVIEW: Anticoagulants in general, but especially the relatively new direct oral anticoagulants and platelet inhibitors, pose a great challenge for physicians in the hemorrhaging patient. The aim of the present review is to provide an overview on recent studies dealing with the reversal of anticoagulation in the hemorrhaging patient and to describe our therapeutic emergency strategy for those patients. RECENT FINDINGS: A specific antidote for dabigatran is already on the market and antidotes for the direct and indirect factor Xa inhibitors are in development...
December 28, 2018: Current Opinion in Anaesthesiology
Gregory E Holt, Kenneth W Goodman, Stephen E Olvey, Daniel Kett
PURPOSE OF REVIEW: Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. RECENT FINDINGS: Studies show both providers and patients confuse the meaning and implication of DNR orders. In the United States, out-of-hospital DNR orders are legislated at the state level. Most states standardized out-of-hospital DNR orders so caregivers can immediately recognize and accept the order and act on its behalf...
December 6, 2018: Current Opinion in Anaesthesiology
Betty E Thomas, Thomas Ledowski
PURPOSE OF REVIEW: Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. RECENT FINDINGS: Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change - even if this may seem to come at a higher cost...
December 6, 2018: Current Opinion in Anaesthesiology
Andrew McGuire, Paul C McConnell
PURPOSE OF REVIEW: Increasing scarcity of resources on the background of ever improving medical care and prolonged life expectancy has placed a burden on all aspects of health care. In this article we examine the current problems with resource allocation in intensive care and question whether we can find guidance on appropriate resource allocation through ethical models. RECENT FINDINGS: The problem of fair and ethical resource allocation has perpetually plagued health care...
December 6, 2018: Current Opinion in Anaesthesiology
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