Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2020
ReviewTerminology, communication, and information systems in nonoperating room anaesthesia in the COVID-19 era.
Nonoperating room anaesthesia (NORA) is a rapidly growing and important area of anaesthesia care. We would contend that anaesthesia informatics principles and innovations that have been widely applied in numerous diverse domains could be successfully applied in NORA environments, resulting in significant improvements in anaesthesia care delivery. ⋯ There is significant opportunity for anaesthesiologists and clinical informaticians to collaborate and apply major advances in the perioperative informatics field to NORA environments, particularly given rapid recent changes in the field during the COVID-19 epidemic. Given the complexity of NORA patients and care delivered in NORA environments, applied clinical informatics has the potential to drastically improve care delivered.
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Curr Opin Anaesthesiol · Aug 2020
ReviewRisk stratification in patients undergoing nonoperating room anesthesia.
A growing numerical and complexity of patients requiring nonoperating room anesthesia (NORA) necessitates a multidisciplinary approach of a highly experienced team in a highly technological setting of the cathlab or radiology suite. These requirements are even more magnified in the context of the coronavirus disease 2019 (COVID-19) pandemic. ⋯ Apart from a thorough preoperative assessment, preventive strategies and well-chosen monitoring should be implemented to preclude inadvertent events in sometimes high-risk patients. Timely preventive measures and early recognition of complications could only be achieved by a multidisciplinary cooperating team. In addition, the implementation of safety measurements due to the infectious transmission to both the patients and care givers is crucial.
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The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA. ⋯ Procedural sedation deserves to have high degree of attention for potential adverse events. New combinations of well established drugs provide a better pharmacokinetic profile, fit to different indications and offer multiple benefits for both provider and patient.
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Curr Opin Anaesthesiol · Aug 2020
ReviewSoft drugs in anesthesia: remifentanil as prototype to modern anesthetic drug development.
The unique demands of modern anesthesia practice require that medications be effective, well tolerated, and efficient. These attributes are increasingly achieved with the soft drug approach, wherein novel active compounds are specifically designed to be susceptible to rapid biotransformation to inactive metabolites. The present review summarizes the historical background and recent trends in soft drug development in anesthesiology. ⋯ With succinylcholine as the historical forerunner and remifentanil as the modern prototype, the soft drug paradigm continues to hold promise for the future of anesthesia drug development.
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Curr Opin Anaesthesiol · Aug 2020
ReviewRecent advances in nonoperating room anesthesia for cardiac procedures.
The number of complex procedures performed in the cardiac catheterization laboratory (CCL) is rapidly increasing. Because of their complexity, they frequently require the assistance of an anesthesiologist. The CCL is primarily designed to facilitate a percutaneous cardiac intervention; therefore, it might be a challenging workplace for an anesthesiologist. The aim of this review is to briefly present tasks and challenges of providing anesthesia in the CCL and to provide a concise description of common cardiac procedures performed there. ⋯ New and fast development of percutaneous cardiac interventions has created a new working place for the anesthesiologist - the CCL. Our expertise in complex cardiac pathophysiology allows conduct of complicated procedures outside of the operating theater. For the same reasons, there is ongoing discussion whether anesthesia support in CCL should be provided by a general or cardiac anesthesiologist.