Friedrich Lersch, Paula Cruz Correia, Darren Hight, Heiko A Kaiser, Joana Berger-Estilita
PURPOSE OF REVIEW: This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes...
September 20, 2023: Current Opinion in Anaesthesiology
Steven Young, Brian Osman, Fred E Shapiro
PURPOSE OF REVIEW: The volume of office-based surgery (OBS) has surged over the last 25-30 years, however patients with increasing comorbidities are being considered for procedures in office locations. This review focuses on office-based surgery outcomes, financial incentives driving this change, and controversies. RECENT FINDINGS: Healthcare economics appear to drive the push towards OBS with improved reimbursements, but there are rising out-of-pocket costs impacting patients...
September 11, 2023: Current Opinion in Anaesthesiology
Corina Bello, Carolina S Romero, Jonathan Heinimann, Melanie Lederer, Markus M Luedi
PURPOSE OF REVIEW: We review current evidence about organizational structures, patient selection criteria, safety measures, economic considerations, quality management, and staffing challenges in ambulatory anesthesia. The focus is on the facilitators and barriers related to the peri-interventional period and the potential concepts and innovations for further development of ambulatory anesthesia services. RECENT FINDINGS: Recent findings shed light on organizational structures in ambulatory anesthesia, including hospital-based centers, freestanding ambulatory centers, and office-based practices...
August 31, 2023: Current Opinion in Anaesthesiology
Davide Chiumello, Isabella Fratti, Silvia Coppola
PURPOSE OF REVIEW: Robotic-assisted laparoscopic radical prostatectomy has become the second most commonly performed robotic surgical procedure worldwide, therefore, anesthesiologists should be aware of the intraoperative pathophysiological consequences. The aim of this narrative review is to report the most recent updates regarding the intraoperative management of anesthesia, ventilation, hemodynamics and central nervous system, during robotic-assisted laparoscopic radical prostatectomy...
August 30, 2023: Current Opinion in Anaesthesiology
Sivasenthil Arumugam, Harish Siddaiah, Hari Kalagara
PURPOSE OF REVIEW: Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point of care applications of ultrasound in perioperative care and anesthetic management with special emphasis on ambulatory practice. RECENT FINDINGS: Point of care ultrasound (POCUS) for anesthesiologists has gained widespread interest and popularity. Recent literature has highlighted multiple perioperative POCUS applications on various organ systems and its benefits...
August 18, 2023: Current Opinion in Anaesthesiology
Lydia Coxon, Emma Evans, Katy Vincent
PURPOSE OF REVIEW: This review looks to overview advances in endometriosis-associated pain, both in understanding the pain mechanisms involved and increasing treatment options with well designed clinical trials and meta-analyses. RECENT FINDINGS: Our understanding of endometriosis-associated pain has progressed from a purely nociceptive model to an awareness that both neuropathic and nociplastic mechanisms can be present for some people with endometriosis. Clinical trials and meta-analyses have demonstrated efficacy of surgical treatments and hormonal therapies...
August 15, 2023: Current Opinion in Anaesthesiology
Alberto E Ardon, Sindhuja Nimma, Olga C Nin
PURPOSE OF REVIEW: To summarize recent evidence that discusses the clinical, financial, and logistical implications of a 23 h stay postsurgical stay unit in an ambulatory surgical center (ASC). RECENT FINDINGS: Twenty-three-hour stays in ambulatory surgery centers are safe, but proper patient selection and optimization are key to maintaining a high level of safety. The financial implications of overnight stays in ASCs rely heavily on payment structures and comparative costs at hospital-based outpatient surgery centers...
August 10, 2023: Current Opinion in Anaesthesiology
Michael I Chen, David Lee, Becky J Wong
PURPOSE OF REVIEW: To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients. RECENT FINDINGS: Recent studies have been published on the anesthetic consideration for functional MRI, robotic-assisted stereoelectroencephalography, high-intensity focused ultrasound, and magnetoencephalography. These articles describe the anesthesia management, risks, and outcome for these procedures...
August 7, 2023: Current Opinion in Anaesthesiology
Daniel Segelcke, Daniela Rosenberger, Esther M Pogatzki-Zahn
PURPOSE OF REVIEW: Prognostic models for chronic postsurgical pain (CPSP) aim to predict the likelihood for development and severity of CPSP in individual patients undergoing surgical procedures. Such models might provide valuable information for healthcare providers, allowing them to identify patients at higher risk and implement targeted interventions to prevent or manage CPSP effectively. This review discusses the latest developments of prognostic models for CPSP, their challenges, limitations, and future directions...
July 28, 2023: Current Opinion in Anaesthesiology
Jacqueline M Morano, Jamie L Uejima, Avery Tung, Joshua M Rosenow
PURPOSE OF REVIEW: The goal of this review is to summarize the perioperative management of noncardiac implanted electrical devices (NCIEDs) and update the anesthesiologist on current recommendations for management when a NCIED is encountered during a nonneurosurgical procedure. RECENT FINDINGS: Indications for NCIEDs continue to expand, and increasing numbers of patients with NCIEDs are presenting for nonneurosurgical procedures. Recent case reports demonstrate that NCIEDs may meaningfully affect perioperative management including use of electrocautery and neuromonitoring...
July 27, 2023: Current Opinion in Anaesthesiology
Antonia Barke, Beatrice Korwisi
PURPOSE OF REVIEW: The purpose is to review the evidence that has been collected with regard to the new classification of chronic pain. In 2022, the World Health Assembly endorsed the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11), and with it a new classification of chronic pain. RECENT FINDINGS: The evidence from the formative field testing indicated that the categories were clearly delineated and the coverage of chronic pain excellent (<3% in remainder categories)...
July 27, 2023: Current Opinion in Anaesthesiology
Kathleen F Vincent, Ken Solt
PURPOSE OF REVIEW: To summarize the recent preclinical findings investigating dopaminergic circuits for their involvement in reversing anesthetic-induced unconsciousness. RECENT FINDINGS: The release of dopamine from the ventral tegmental area onto dopamine D1 receptor-expressing neurons in the nucleus accumbens promotes emergence following general anesthesia. Two relevant targets of dopamine D1 receptor-expressing neurons in the nucleus accumbens include the lateral hypothalamus and ventral pallidum...
July 11, 2023: Current Opinion in Anaesthesiology
Keith J Ruskin, Richard P Dutton, Anna Clebone Ruskin
PURPOSE OF REVIEW: Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways...
June 29, 2023: Current Opinion in Anaesthesiology
Mariana Restrepo-Holguin, Sandra L Kopp, Rebecca L Johnson
PURPOSE OF REVIEW: To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. RECENT FINDINGS: Distal peripheral nerve blocks may allow for preserved quadriceps motor strength and comparable analgesia to traditional techniques...
June 26, 2023: Current Opinion in Anaesthesiology
Remco Vellinga, Douglas J Eleveld, Michel M R F Struys, Johannes P van den Berg
PURPOSE OF REVIEW: There are various pharmacokinetic-dynamic models available, which describe the time course of drug concentration and effect and which can be incorporated into target-controlled infusion (TCI) systems. For anesthesia and sedation, most of these models are derived from narrow patient populations, which restricts applicability for the overall population, including (small) children, elderly, and obese patients. This forces clinicians to select specific models for specific populations...
October 1, 2023: Current Opinion in Anaesthesiology
Ehab Farag, Sandra Machado, Maged Argalious
PURPOSE OF REVIEW: The brain is the command center of the rest of the body organs. The normal multiorgan talks between the brain and the rest of the body organs are essential for the normal body homeostasis. In the presence of brain injury, the disturbed talks between the brain and the rest of body organs will result in several pathological conditions. The aim of this review is to present the most recent findings for the pathological conditions that would result from the impaired multiorgan talks in the presence of brain injury...
October 1, 2023: Current Opinion in Anaesthesiology
Neeraja Ajayan, Ajay Prasad Hrishi, Girija Prasad Rath
PURPOSE OF REVIEW: This article delves into recent advances in same-day neurosurgery (SDNS), specifically concerning indications, perioperative protocol, safety, and outcomes. Additionally, it explores the recent updates on awake craniotomy and awake spine surgery. RECENT FINDINGS: There is an evolving body of literature on studies about SDNS that reaffirm its safety and feasibility. awake craniotomy is associated with lesser neurological deficits and better survival benefits in patients with lesions in eloquent areas...
October 1, 2023: Current Opinion in Anaesthesiology
Alexander B Stone, Markus W Hollmann, Lotte E Terwindt, Philipp Lirk
PURPOSE OF REVIEW: Chronic postamputation pain (cPAP) remains a clinical challenge, and current understanding places a high emphasis on prevention strategies. Unfortunately, there is still no evidence-based regimen to reliably prevent chronic pain after amputation. RECENT FINDINGS: Risk factors for the development of phantom limb pain have been proposed. Analgesic preventive interventions are numerous and no silver bullet has been found. Novel techniques such as neuromodulation and cryoablation have been proposed...
October 1, 2023: Current Opinion in Anaesthesiology
Daniel Taraskiewicz, Jessica Sheeran, Paul De Marco, Mohamed Tiouririne, Nabil Elkassabany
PURPOSE: The purpose of this article is to provide readers with a concise overview of the cause, incidence, treatment of, and sequalae of postdural puncture headaches (PDPH). Over the past 2 years, much data has been published on modifiable risk factors for PDPH, treatments for PDPH, and sequalae of PDPH particularly long-term. RECENT FINDINGS: There is emerging data about how modifiable risk factors for PDPH are not as absolute as once believed. There have been several new meta-analysis and clinical trials published, providing more data about effective therapies for PDPH...
October 1, 2023: Current Opinion in Anaesthesiology
Caleb Ing, Laszlo Vutskits
PURPOSE OF REVIEW: This article reviews recent advances and controversies of developmental anesthesia neurotoxicity research with a special focus on the unanswered questions in the field both from clinical and preclinical perspectives. RECENT FINDINGS: Observational cohort studies of prenatal and early childhood exposure to anesthesia have reported mixed evidence of an association with impaired neurodevelopment. Meta-analyses of currently available studies of early childhood exposure to anesthesia suggest that, while limited to no change in general intelligence can be detected, more subtle deficits in specific neurodevelopmental domains including behavior and executive function may be seen...
October 1, 2023: Current Opinion in Anaesthesiology
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