Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2021
ReviewA decade later, there are still major issues to be addressed in paediatric anaesthesia.
Despite real advances in paediatric anaesthesia management, such as a growing awareness of the relevance of anaesthesia conduct as well as of the lack of evidence for neurotoxicity of anaesthetic agents, it must be said that there are still important questions in our specialty that remain unanswered. Standardization and harmonization of airway management, analgesia techniques and outcome measures are the important issues we are facing at the beginning of this decade. ⋯ The shift in research from the neurotoxicity of anaesthetic agents to factors related to anaesthetic conduct are discussed. Examples for an improvement in anaesthesia management are highlighted with advocacy for including these evidence-based findings in routine clinical practice. Finally, the impact of using clinically relevant age-related and patient-centred perioperative outcomes is essential for comparing and/or interpreting the safety and efficacy of anaesthesia and analgesia management in children.
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Opioid use disorder (OUD) in pregnancy has more than quadrupled in prevalence over the past two decades and continues to increase steadily every year. With no defined standard of care for the management of pain during the peripartum period, variability in treatment plans potentially leaves room for interrupted patient care, decreased patient satisfaction, and poorer outcomes. The impact of OUD and its management during the peripartum period has become more widely discussed over the past several years and is the focus of this review. ⋯ This review will address both pain management recommendations and best clinical practices regarding management of the parturient during the transition periods of the peripartum, intrapartum, and postpartum period. Novel approaches and perspectives from case reports and narrative experience will also be discussed. There are many opportunities in this field for further studies, research, and evidence-based guidelines that promote an established standard of care.
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Curr Opin Anaesthesiol · Jun 2021
ReviewPerioperative frailty: lessons learned and future directions.
As the surgical population ages, preoperative diagnosis and optimization of frailty becomes increasingly important. Various concepts are used to define frailty, and several tools have been validated for use in the perioperative period. This article reviews current conceptual frameworks of frailty, references current literature and provides a practical approach to the preoperative frailty assessment with a focus on potential interventions. ⋯ Emerging evidence suggests that frailty may be mitigated with patient-specific, multidimensional preoperative interventions, thus potentially improving postoperative outcomes in this vulnerable patient population.
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Curr Opin Anaesthesiol · Jun 2021
ReviewPeripartum optimization and coordination of collaborative care practice: a critical role for the obstetric anesthesiologist in combating maternal morbidity and mortality.
Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation. ⋯ Obstetric anesthesiologists have a critical role not only in preoperative patient optimization but also in coordinating multidisciplinary care for optimal patient outcomes.