Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2020
ReviewSugammadex and neuromuscular reversal: special focus on neonatal and infant populations.
Sugammadex is a novel selective muscle relaxant binding agent capable of reversing deep neuromuscular blockade from rocuronium or vecuronium. It has not been approved for use in children by the US FDA because of lack of literature regarding pediatric patients. ⋯ All available evidence suggests that sugammadex is likely well tolerated and effective and can be dosed similarly to adults in patients 2 years' old and greater. Sugammadex should be used with caution in patients less than 2 years old.
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Curr Opin Anaesthesiol · Jun 2020
ReviewPrehabilitation: the anesthesiologist's role and what is the evidence?
Surgery poses major threats to functional independence. Prehabilitation is a preoperative conditioning intervention that aims to prevent or attenuate surgery-related functional decline and its consequences. The present review is to summarize most recent evidence on the effectiveness of prehabilitation on key topics in cancer care, such as perioperative functional capacity, surgical and oncologic outcomes. ⋯ Prehabilitation prevents functional decline associated with major cancer surgery. Evidence is still needed to support its effectiveness in relation to postoperative complication, length of hospital stay, tumor progression, response to medical treatment, and survival. Ongoing and future research is essential to prompt the role of perioperative medicine in cancer care.
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Curr Opin Anaesthesiol · Jun 2020
ReviewPre and postoperative risk management: the role of scores and biomarkers.
The goal of risk prediction is to identify high-risk patients who will benefit from further preoperative evaluation. Clinical scores and biomarkers are very well established tools for risk prediction but their accuracy remains a controversial issue. ⋯ Different risk indices and biomarkers might lead to varying risk estimates. However, the importance of clinical judgment in risk assessment should not be underestimated.
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Curr Opin Anaesthesiol · Jun 2020
ReviewPerioperative anaphylaxis: diagnostic challenges and management.
Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from recent guidelines on the acute management of life-threatening anaphylaxis are presented. ⋯ Perioperative hypersensitivity reactions are rare but can be life-threatening. A high index of suspicion should be maintained for their successful management. Whenever a perioperative hypersensitivity reaction is suspected, close collaboration between anaesthetist and the allergy team investigating the patient is paramount, in order for the patient to be appropriately investigated and have an uneventful anaesthetic in the future.
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Curr Opin Anaesthesiol · Jun 2020
ReviewCongenital heart disease in adults (when kids grow up) pediatric geriatric anesthesia.
The current review focuses on the new development of adult congenital heart disease (ACHD) patients in the areas of imaging, percutaneous interventions, ventricular assist devices and transplantation. ⋯ Motta summary clip: http://links.lww.com/COAN/A65.