Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2020
ReviewUpdates in periprocedural management of direct oral anticoagulants.
As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs). ⋯ With the exception of no clinically relevant bleeding risk or certain electrophysiology procedures, DOACs should be discontinued periprocedurally in accordance with bleeding risks and drug's half-life. Bridging is generally not recommended for DOACs.
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Curr Opin Anaesthesiol · Jun 2020
ReviewAnesthesia teams managing pacemakers and ICDs for the perioperative period: enhanced patient safety and improved workflows.
There have been both technological and philosophical advances over the last decade regarding pacemakers and implanted cardioverter defibrillators (ICDs). Collectively, these devices are currently referred to as cardiac implantable electronic devices (CIEDs). Technological advances include the introduction of leadless pacemakers, subcutaneous defibrillators and cardiac event recorders, enhancements regarding compatibility of CIEDs for MRI scanning, the ability to interrogate devices remotely, and improved programming modes that preserve battery life. Philosophical advances have been mainly in the area of perioperative management of CIED patients. ⋯ Educated anesthesia teams can independently manage the vast majority of CIED patients perioperatively with magnet application alone. Furthermore, this portends enhanced patient safety and improved workflows in the perioperative period.
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Both cannabis and e-cigarette use are increasing, particularly among adolescents. The use of cannabis products may impact patients' physiology under anesthesia. Understanding the effects of cannabis and vaping are critical to the provision of safe and effective anesthetic care. ⋯ There is a very wide variety of cannabis products currently available, with respect to both route of administration as well as cannabinoid content. Patients using cannabis products prior to anesthesia may present with altered physiology that place them at increased risk for cardiovascular and respiratory complications. They may also be tolerant to the effects of propofol and opioid for pain management, thus consideration should be given to use of a multimodal regimen.
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Curr Opin Anaesthesiol · Jun 2020
ReviewFetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions.
This review describes maternal and fetal anesthetic management for noncardiac fetal surgical procedures, including the management of lower urinary tract obstruction, congenital diaphragmatic hernia (CDH), myelomeningocele, sacrococcygeal teratoma, prenatally anticipated difficult airway and congenital lung lesions. ⋯ Maternal and fetal anesthetic management is tailored to the fetal intervention and the underlying health of the fetus and mother.
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Curr Opin Anaesthesiol · Jun 2020
ReviewAugmented intelligence in pediatric anesthesia and pediatric critical care.
Acute care technologies, including novel monitoring devices, big data, increased computing capabilities, machine-learning algorithms and automation, are converging. This enables the application of augmented intelligence for improved outcome predictions, clinical decision-making, and offers unprecedented opportunities to improve patient outcomes, reduce costs, and improve clinician workflow. This article briefly explores recent work in the areas of automation, artificial intelligence and outcome prediction models in pediatric anesthesia and pediatric critical care. ⋯ Most studies focusing on artificial intelligence demonstrate good performance on prediction or classification, whether they use traditional statistical tools or novel machine-learning approaches. Yet the challenges of implementation, user acceptance, ethics and regulation cannot be underestimated. Areas in which there is easy access to routinely labeled data and robust outcomes, such as those collected through national networks and quality improvement programs, are likely to be at the forefront of the adoption of these advances.