Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2023
ReviewTotal intravenous anesthesia versus inhalation anesthesia: how do outcomes compare?
Surgical procedures that involve general anesthesia are performed with either volatile anesthetics or propofol-based total intravenous anesthesia. Both techniques are safe and provide appropriate conditions for surgery. Despite being a well established anesthetic, the use of propofol-based total intravenous anesthesia (TIVA) remains low. Possible explanations include the perceived increase risk of awareness, lack of target controlled infusion devices, increased turnover time for device set up and individual preference. ⋯ In this review we will summarize the clinical evidence comparing the effect of propofol-based TIVA and volatile anesthetic on postoperative outcomes such as postoperative nausea and vomiting, postoperative pain, quality of recovery, postoperative cognitive dysfunction and cancer outcomes.
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Curr Opin Anaesthesiol · Aug 2023
ReviewClarifying the grey space of sugammadex induced bradycardia.
This review describes recent prospective and retrospective work exploring the incidence and clinical consequence of sugammadex-induced bradycardia and an update of recent evidence and adverse event reports to the United States Food and Drug Administration regarding the incidence of sugammadex induced bradycardia. ⋯ Sugammadex-induced bradycardia is common and, in most instances, of minimal clinical consequence. Nevertheless, anesthesia providers should maintain proper monitoring and vigilance to treat hemodynamical instability with each administration of sugammadex.
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Curr Opin Anaesthesiol · Aug 2023
ReviewManagement of anesthetic complications outside the operating room.
Nonoperating room anesthesia (NORA) procedures have seen a significant growth over the years along with an increase in the complexity and severity of cases. Providing anesthesia care in these often-unfamiliar locations is risky, and complications are common. This review aims to report the most recent updates regarding managing anesthesia-related complications in patients undergoing procedures in non-operating room locations. ⋯ Delivery of anesthesia care in out-of-operating room locations is associated with significant challenges. Meticulous planning, close communication with the procedural team, establishing protocols and pathways for help, along with interdisciplinary teamwork can facilitate safe, efficient, and cost-effective procedural care in the NORA suite.
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Curr Opin Anaesthesiol · Aug 2023
ReviewPharmacokinetic and pharmacodynamic drug display and simulation systems in anesthesia practice.
This review explores the use of tools and displays based on pharmacokinetic and pharmacodynamic (PK/PD) modelling of drugs used in anesthesia. The primary focus is on those tools designed to illustrate the interactions between two or more drugs, or classes of drugs, and in particular, their use in a real-time clinical support role. Off-line, educational tools are also explored. ⋯ PK/PD simulation is a useful tool for exposition of the relationship between drug dosing and effect. The initial promise of real-time tools has yet to be realized in routine clinical practice.
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Curr Opin Anaesthesiol · Aug 2023
ReviewRegional anesthesia in the emergency department outside the operating theatre.
Moderate to severe pain is common and remains a significant problem in the emergency department and regional anesthesia provides optimal and safe pain relief. This review aims to discuss the benefits, indications of the most common ultrasound-guided regional anesthesia techniques that can be provided by clinicians in the emergency department as part of multimodal analgesia. We will also comment on the education and training for effective and safe ultrasound-guided regional anesthesia in the emergency department. ⋯ Emergency physicians are perfectly placed to utilize the advantages of ultrasound-guided regional anesthesia. Various techniques can now be employed to cover most of the painful injuries presenting to the emergency department, thus modifying the morbidity and outcomes of emergency patients. Some of the new techniques require minimal training, provide safe and effective pain relief with low risk of complications. Ultrasound-guided regional anesthetic techniques should form an integral part of the curriculum of emergency department physicians.