Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2019
ReviewPharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery.
The present review aims to propose pharmacological strategies to enhance current clinical practices for analgesia in ambulatory surgical settings and in the context of the opioid epidemic. ⋯ These strategies must combine three key components when not contraindicated: regional/local analgesia, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs). Adjuvants such as gabapentinoids, N-methyl-D-aspartate receptor modulators, glucocorticoids, α2-adrenergic receptor agonists, intravenous lidocaine might be added to the initial multimodal strategy, however, caution must be used regarding their side effects and risks of delaying recovery after ambulatory surgery. Weaker opioids (e.g. oxycodone, hydrocodone, tramadol) could be used rather than more powerful ones (e.g. morphine, hydromorphone, inhaled fentanyl, sufentanil). This, combined with education about postoperative weaning of opioids after surgery must be done in order to avoid long-term reliance of these drugs.
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Curr Opin Anaesthesiol · Dec 2019
ReviewHow to optimize neuromuscular blockade in ambulatory setting?
The purpose of this review is to discuss the optimal use of neuromuscular blocking agents (NMBA) during ambulatory surgery, and to provide an update on the routine use of neuromuscular monitoring and the prevention of residual paralysis. ⋯ Recent data suggest that it is now possible to obtain a tight control of neuromuscular block to maintain optimal relaxation tailored to the surgical requirements and to obtain a rapid and reliable recovery at the end of the procedure.
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Surgery, invasive procedures and anesthesia itself may induce an inflammatory response in the patient. This represents an evolutionary inherited and conserved response of the host to environmental stimuli and may lead to both beneficial and potentially harmful effects. This review highlights the mechanisms of anesthesia-induced and perioperative immune modulation. ⋯ The current review will highlight the current knowledge on the perioperative anesthesia-induced and surgery-induced modulation of the immune response and also address possible intervention strategies for the development of future therapeutic approaches.
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The difficult airway remains an ongoing concern in daily anesthesia practice, with awake intubation being an important component of its management. Classically, fiberoptic bronchoscope-assisted tracheal intubation was the method of choice in the awake patient. The development of new generation videolaryngoscopes has revolutionized the approach to tracheal intubation in the anesthetized patient. The question whether videolaryngoscopes have a place in the intubation of the difficult airway in the awake patient is currently being addressed. ⋯ Videolaryngoscopy is a valid technique that should be considered for difficult airway management in the awake patient.