Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2022
ReviewReview of pediatric hypercarbia and intraoperative management.
Hypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. ⋯ Pediatric anesthesiologists and their teams must remain vigilant and anticipate these developments. Care must be taken to avoid any rapid changes in these vulnerable patients to minimize risks of adverse outcomes.
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Curr Opin Anaesthesiol · Apr 2022
ReviewExtracorporeal cardiopulmonary resuscitation: is it futile?
Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment modality used to restore end-organ perfusion in the setting of refractory cardiac arrest in patients receiving cardiopulmonary resuscitation (CPR). Despite advances in medicine, survival from cardiac arrest remains low with conventional CPR. The body of literature relating to ECPR is limited to retrospective studies and case series, with data that are inconsistent. Routine use of ECPR is not currently endorsed by the American Heart Association. ⋯ ECPR may be considered as an adjunct to CPR in cases of refractory cardiac arrest. The success of ECPR relies on specialized expertise, thoughtful patient selection, and timely initiation.
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Curr Opin Anaesthesiol · Apr 2022
ReviewThe efficacy of apneic oxygenation to prevent hypoxemia during rapid sequence intubation in trauma patients.
Rapid and effective airway management is priority for trauma patients. Trauma patients are often at an increased risk of experiencing hypoxia, and thus at increased risk of morbidity and mortality. Apneic oxygenation has been widely debated but has been reported to provide benefit in terms of increased peri-intubation oxygen saturation and decreased rates of desaturation. This review aims to evaluate the current literature on the efficacy of apneic oxygenation in the setting of rapid sequence intubation (RSI) in trauma patients. ⋯ The use of apneic oxygenation can play an important role in preventing hypoxic events in trauma patients undergoing RSI. The use of apneic oxygenation is cheap, and should be considered to reduce hypoxemic events. Additional studies are required to see the effects of apneic oxygenation on outcomes in trauma patients undergoing RSI, specifically desaturation and hypoxemic events and duration, and early onset mortality.
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Curr Opin Anaesthesiol · Apr 2022
ReviewPerioperative acute kidney injury: impact and recent update.
Acute kidney injury (AKI) is common in hospitalized patients and is a major risk factor for increased length of stay, morbidity, and mortality in postoperative patients. There are multiple barriers to reducing perioperative AKI - the etiology is multi-factorial and the diagnosis is fraught with issues. We review the recent literature on perioperative AKI and some considerations for anesthesiologists that examine the far-reaching effects of AKI on multiple organ systems. ⋯ Recent studies address the use of risk stratification models and biomarkers, more sensitive than creatinine, in the preoperative identification of patients at risk for AKI. Although exciting, these scores and models need validation. There is a need for research assessing whether early AKI detection improves outcomes. Enhanced recovery after surgery utilizing goal-directed fluid therapy has not been shown to make an appreciable difference in the incidence of AKI. Reducing perioperative AKI requires a multi-pronged and possibly disease-specific approach.
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Curr Opin Anaesthesiol · Apr 2022
ReviewA not so sweet scenario: impact of perioperative glucose control on regional anesthetic techniques for orthopedic surgery.
Diabetes and hyperglycemia are well established risk factors for complications associated with common orthopedic surgeries. In some practice settings, these conditions are also viewed as contraindications to regional nerve catheters. In this article, we aim to present our approach to offering the benefits of this modality in a safe manner for patients with diabetes and even some with preexisting, localized infections. ⋯ Based on our experience and reading of the literature, we advocate for a liberalized approach to use of continuous regional anesthesia for diabetic patients having for orthopedic surgery. A set of consensus guidelines tailored to institutions' resources and monitoring capabilities can be a useful tool for standardizing care. It may also increase access to the clinical benefits of this modality in a population particularly vulnerable to opioid related adverse effects.