Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2022
ReviewChallenges and outcomes in airway management outside the operating room.
Airway management outside the operating room poses unique challenges that every clinician should recognize. These include anatomic, physiologic, and logistic challenges, each of which can contribute to complications and lead to poor outcomes. Recognizing these challenges and highlighting known outcome data may better prepare the team, making this otherwise daunting procedure safer and potentially improving patient outcomes. ⋯ Emergency airway management outside the operating room remains a high-risk procedure, associated with poor outcomes. Pre-intubation hemodynamic optimization may mitigate some of the risks, and future research should focus on identification of best strategies for hemodynamic optimization prior to and during this procedure.
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Despite significant advances in trauma management over the last twenty years, uncontrolled hemorrhage remains the leading cause of preventable death in trauma. We review recent changes affecting hemorrhage control resuscitation. ⋯ Improving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.
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Curr Opin Anaesthesiol · Apr 2022
ReviewRegional anesthesia and the acute pain service: compliance and controversies.
The aims of this article are three-fold: first, to describe the necessary elements that result in accurate and compliant billing practice; second, to discuss billing in the context of new blocks and liposomal bupivacaine; and third, to gain a better understanding of compliance law. ⋯ Familiarity with documentation, billing, and compliance requirements can help maintain proper reimbursement rates, as well as limit potential downstream consequences. Most importantly this can help increase the viability and success of an acute pain service.
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Curr Opin Anaesthesiol · Apr 2022
ReviewWhen is it safe to resume anticoagulation in traumatic brain injury?
When to resume or initiate anticoagulation therapy following traumatic brain injury (TBI) is controversial. This summary describes the latest evidence to guide best practice. ⋯ Strategies and timing to start prophylactic and TAC differ significantly between institutions and physicians. Each TBI patient should be evaluated on a case-by-case basis on when to start anticoagulation. More investigation is required to guide best practice.
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Curr Opin Anaesthesiol · Apr 2022
ReviewExtubation of the potentially difficult airway in the intensive care unit.
Extubation in the intensive care unit (ICU) is associated with a failure rate requiring reintubation in 10-20% patients further associated with significant morbidity and mortality. This review serves to highlight recent advancements and guidance on approaching extubation for patients at risk for difficult or failed extubation (DFE). ⋯ Extubation in the ICU remains an elective decision and patients found to be at risk should be further optimized and planning undertaken prior to proceeding. Extubation for the at-risk patient should be operationalized utilizing easily reproducible strategies, with airway experts present to guide decision making and assist in reintubation if needed.