Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2022
ReviewAirway misadventures in adult critical care: a concise narrative review of managing lost or compromised artificial airways.
Loss or compromise of artificial airways in critically ill adults can lead to serious adverse events, including death. In contrast to primary emergency airway management, the optimal management of such scenarios may not be well defined or appreciated. ⋯ Management of lost or otherwise compromised artificial airways is a key skill set for adult critical care clinicians alongside primary emergency airway management.
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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
ReviewExamining intersectionality in anesthesiology training, academics, and practice.
Intersectionality, or the overlapping nature of social categorizations, such as race, class, and gender, creates interdependent systems of discrimination, disadvantage, and health disparities. The present review examines common shortcomings to diversity management, and proposes targeted improvement frameworks for anesthesiology departments that would offer competitive advantage in training, hiring, and retention, and improved care delivery aimed toward reducing health disparities. ⋯ The synergy of intersectionality mounts considerable challenges that impact patients, colleagues, and communities of practice. Examining intersectionality in education and workplace policy affords tremendous opportunity for improving quality of care for marginalized populations, reducing healthcare costs, and normalizing culture that is inclusive, equitable, and empowering.
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Curr Opin Anaesthesiol · Apr 2022
ReviewSurgical rib fixation in traumatic rib fractures: is it warranted?
Traumatic chest wall injuries and rib fractures remain a prevalent injury. Despite many advances, these injuries result in high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) is increasing in utilization with expanding indications. Recent studies have demonstrated that many patients may benefit from surgical intervention. ⋯ SSRF has become more prevalent with improving outcomes for patients. Understanding the indications will help expand utilization and improve patient outcomes.
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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.