Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2018
ReviewExtended release bupivacaine formulations for postoperative analgesia: an update.
New formulations of local anesthetics with sustained release and longer duration of action are being developed to improve patient outcomes following surgery. This review summarizes the efficacy and safety of the three most recently developed extended-release formulations of the local anesthetic, bupivacaine. ⋯ Extended-release bupivacaine formulations are promising alternatives to prolong duration of analgesia. To date, only EXPAREL has been approved by the FDA for tissue infiltration during surgery and for interscalene nerve block.
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Curr Opin Anaesthesiol · Oct 2018
ReviewFluid management concepts for severe neurological illness: an overview.
The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. ⋯ As the possibility grows closer that we can monitor the physiological parameters with direct relevance for neurological outcomes and the various complications associated with neurocritical illness, we may finally move away from static therapy recommendations, and toward individualized, precise therapy. Although we believe therapy should ultimately be individualized rather than standardized, it is clear that the monitoring tools and analytical methods used ought to be standardized to facilitate appropriately powered, prospective clinical outcome trials.
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Curr Opin Anaesthesiol · Oct 2018
ReviewEducation in neuroanesthesia and neurocritical care: trends, challenges and advancements.
We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. ⋯ High-fidelity simulation in perioperative care of neurosurgical patients can be part of formal neuroanesthesia and NCC curricula, and potentially impact trainees' proficiency. A research agenda is needed to validate the assessment of most effective educational interventions in neurosciences trainees with diverse medical backgrounds. Creative combinations of cost-effective interventions including traditional teaching, specific technical skills workshops, low and high-fidelity simulation deserve to be assessed in future studies.
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Curr Opin Anaesthesiol · Oct 2018
ReviewPeriprocedural management of patients with subarachnoid hemorrhage.
Anesthesiologists and intensivists may be involved in the management of aneurysmal subarachnoid hemorrhage (aSAH) patients at various stages of care. This article will review the recent advances in the periprocedural management of aSAH patients. ⋯ Despite recent progress in the scoring, diagnosis, and treatment of aSAH patients, the periprocedural management of these patients is still a major challenge for anesthesiologists and intensivists, who are involved from the first phase of the aneurysm rupture through the postoperative phases and vasospasm period.
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To highlight the potential implications of recent advances in the management of large vessel occlusions for intraprocedural anesthetic management. ⋯ Management strategies that shorten the time to intervention and maintain blood pressure to preserve penumbral tissue may be beneficial. Future well powered studies are necessary to enable inferences on what type of anesthetic management is harmless, neurotoxic, or neural plasticity promoting.