Current opinion in anaesthesiology
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Adverse long-term impact of general anesthesia on the developing brain is a widely discussed and controversial issue with potential public health relevance. The goal of this article is to give insights into the most recent experimental and clinical observations aimed to advance our understanding in this field. ⋯ Experimental data with reasonable translational relevance suggest that early-life exposure to general anesthetics can induce lasting behavioral and cognitive deficits. In contrast, human studies provide, at best, mixed evidence about developmental anesthesia neurotoxicity. Future research, both experimental and human, is needed to clarify this important issue.
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Curr Opin Anaesthesiol · Dec 2017
ReviewAre we fully utilizing the functionalities of modern operating room ventilators?
The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. ⋯ The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. VIDEO ABSTRACT: http://links.lww.com/COAN/A47.
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Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent benefits in patients undergoing colorectal, urological and thoracic surgeries. Principles of these protocols and their advantages are expected to extend into other surgical specialties such as bariatric surgery. In this review, we summarize the components of ERAS protocols for bariatric surgery and present the evidence on the emerging role of ERAS principles in obese patients. ⋯ ERAS for bariatric surgery is in its early phase. Nevertheless, literature supports its role in improving perioperative outcomes compared with conventional care in this scenario. Evidence-based protocols, multidisciplinary teamwork and meticulous audit seem to be the key factors for success in ERAS methodology.
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Curr Opin Anaesthesiol · Feb 2017
ReviewEpidemiology and pathophysiology of cardiac surgery-associated acute kidney injury.
Acute kidney injury (AKI) remains a serious complication of cardiac surgery. An understanding of the epidemiology and pathophysiology of AKI in cardiac surgery patients is crucial to early recognition and proper management. ⋯ Investigators should aim to use consistent criteria for defining AKI in future studies. Efforts should be taken to use actual measurements rather than estimated values of baseline serum creatinine whenever possible. Further study of the more recently proposed pathophysiologic factors contributing to cardiac surgery-associated AKI, such as circulating damage-associated molecular patterns, venous congestion, and genetic predisposition, are warranted.
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Our review of current literature within the past 12-24 months for the treatment of lumbar spinals stenosis (LSS) serves to update providers on recent advances and comparisons regarding therapy spanning lifestyle modification, pharmacologic therapy, minimally invasive interventions, and surgical interventions. ⋯ Our review of current research demonstrates there is a positive role for the current conservative therapies, with favorable results for interventions such as minimally invasive decompression and SCS. Pharmacologic interventions such as systemic prostaglandin analogues and epidural agents such as calcitonin demonstrate early promise, but need to undergo additional safety testing and confirmatory trials. Further long-term research with validated, objective measurements for the aforementioned treatments are needed to draw any definitive conclusions for clinical practice.