Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2024
ReviewLong-term intravenous devices: a narrative review of their placement.
This review summarizes the latest findings and recommendations about the characteristics, indications and use of peripheral and central long-term venous access devices.The various complications inherent in these devices are becoming better known, and their contributing factors determined, which could make it possible to reduce their incidence. ⋯ Improving understanding of the phenomena leading to infectious and thrombotic complications, as well as better knowing the differences between intravenous devices and their respective indications, should lead to improvement of in-hospital and out-of-hospital care.
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Drug development to support anaesthesia and sedation has been slow with few candidates emerging from preclinical discovery and limited innovation beyond attempted reformulation of existing compounds. ⋯ To make progress in a large-volume, low margin and highly competitive environment requires meaningful advances in relevant basic science. Opportunities exist, but probably require bolder initiatives than further attempts at reformulation or fiddling with the structure of propofol. Extending development ambitions to include nonanaesthesiologist providers challenges professional boundaries but may facilitate cost-effective changes in patterns of care.
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Curr Opin Anaesthesiol · Aug 2024
ReviewPlace of high-flow nasal oxygen in nonoperating room anesthesia.
This article aims to assess the utility of high-flow nasal oxygen (HFNO) therapy in nonoperating room anesthesia (NORA) settings. ⋯ HFNO emerges as a compelling alternative to conventional oxygen delivery methods for preventing hypoxemia during procedural interventions in NORA. However, its utilization should be reserved for patients at moderate-to-high risk to mitigate the impact of cost and environmental factors.
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Curr Opin Anaesthesiol · Aug 2024
ReviewThe drug titration paradox: a control engineering perspective.
The drug titration paradox describes that, from a population standpoint, drug doses appear to have a negative correlation with its clinical effect. This paradox is a relatively modern discovery in anesthetic pharmacology derived from large clinical data sets. This review will interpret the paradox using a control engineering perspective. ⋯ This drug titration paradox describes the constraints of how the average clinician will dose a patient with an unknown clinical response. While our understanding of the paradox is still in its infancy, it remains unclear how alternative dosing schemes, such as through automation, may exceed the boundaries of the paradox and potentially affect its conclusions.