Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2020
ReviewIs there a place for regional anesthesia in nonoperating room anesthesia?
General anesthesia and monitored anesthesia care (MAC) are the most widely used techniques in nonoperating room anesthesia (NORA). However, regional anesthesia is slowly finding viable applications in this field. This review aims at providing an update on the current practice of regional anesthesia techniques outside of the operating theatre. ⋯ Regional anesthesia is finding its way into broader applications every day, offering a range of potential benefits in anesthetic care. Its implementation in NORA is promising and may aid in decreasing patient morbidity. However, great care should be taken in applying the recommended safety precautions for regional anesthesia in any setting.
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The present review aims to address the feasibility of opioid free anesthesia (OFA). The use of opioids to provide adequate perioperative pain management has been a central practice of anesthesia, and only recently has been challenged. Understanding the goals and challenges of OFA is essential as the approach to intraoperative analgesia and postsurgical management of pain has shifted in response to the opioid epidemic in the United States. ⋯ The feasibility of OFA is evident. However, there are limitations of this approach that warrant discussion including the potential for adverse drug interactions with multimodal analgesics, the need for providers trained in regional anesthesia, and the management of pain expectations. Additionally, minimizing opioid use perioperatively also requires a change in current prescribing practices. Monitors that can reliably quantify nociception would be helpful in the titration of these analgesics and enable anesthesiologists to achieve the goal in providing personalized perioperative medicine.
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Curr Opin Anaesthesiol · Aug 2020
ReviewNonoperating room anesthesia in different parts of the world.
Advances in early diagnosis and treatment of diseases using minimally invasive procedures has led to an increase in the number of cases in locations outside the operating room. This surge created the need for anesthesia services to expand to these areas to provide well tolerated and favorable procedural conditions. The present review describes nonoperating room anesthesia patterns in different parts of the world. ⋯ There are marked variations in how anesthesia services are delivered in out of operating room locations in different parts of the world. Although there are some data available from the United States, expansion of minimally invasive procedures across continents will likely lead to the emergence of various models of delivering anesthetic care.
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Curr Opin Anaesthesiol · Aug 2020
ReviewThe role of pharmacokinetics and pharmacodynamics in clinical anaesthesia practice.
Growing concerns about the environmental effects of volatile anaesthetics are likely to lead to increased use of intravenous anaesthetic drugs. Pharmacokinetic/pharmacodynamic (PKPD) models can increase the accuracy of intravenous drug titration, especially in populations that differ from the 'average.' However, with a growing number of PKPD models, and other technology available to date, it can be hard to see the wood for the trees. This review attempts to guide the reader through the PKPD jungle. ⋯ Newer and more complex modelling techniques and technological advancements can help to deliver anaesthetic drugs, sedatives and other drugs in a more stable and thereby safer way.
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Curr Opin Anaesthesiol · Aug 2020
ReviewThe anesthesiologist and global climate change: an ethical obligation to act.
Pollution and global warming/climate change contribute to one-quarter of all deaths worldwide. Global healthcare as a whole is the world's fifth largest emitter of greenhouse gases, and anesthetic gases, intravenous agents and supplies contribute significantly to the overall problem. It is the ethical obligation of all anesthesiologists to minimize the harmful impact of anesthesia practice on environmental sustainability. ⋯ The 5 R's of waste minimization in the operating room (OR) (Reduce, Reuse, Recycle, Rethink and Research) have proven benefit in reducing the environmental impact of the practice of anesthesiology, as well as in reducing costs.