Current opinion in anaesthesiology
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The labor and delivery unit poses unique challenges for the clinician faced with an ethical dilemma. Ethics training for physicians is heterogeneous and may not include specifics that are relevant to the obstetric anesthesiologist such as the implications of caring for a maternal-fetal dyad. ⋯ Principlism is the most commonly applied ethical theory in clinical medicine. The four principles are autonomy, beneficence, nonmaleficence, and justice. These principles are prima facie in that no one is defined as being consistently more important than another; it is the clinical situation that determines how to prioritize the principles. This framework allows the obstetric anesthesiologist to assess and manage each of these principles to provide ethically appropriate care for their patient. The aim of this article is to provide the obstetric anesthesiologist with an understanding of the foundational ethical principles that impact the ability to fulfill their fiduciary duty to advocate for patients by offering, and with informed consent, providing indicated and appropriate interventions.
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Curr Opin Anaesthesiol · Feb 2025
Towards optimization in the use of hemostatic agents and blood products in the early treatment of patients with traumatic brain injury (TBI).
The treatment of patients with traumatic brain injury (TBI) with subsequently evolving hemostatic failure and hemorrhagic lesion progression remains challenging. New studies highlight windows of opportunity for treatment optimization. ⋯ Mortality in TBI with subsequent evolving hemostatic failure can be reduced through treatment optimization delivering early prehospital high-dose tranexamic acid and in-hospital goal-directed treatment algorithms to timely correct coagulopathy and restore hemostasis.
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Curr Opin Anaesthesiol · Feb 2025
Current opinion: an overview of sickle cell disease and chronic pain and perioperative considerations.
This review aims to provide the practicing anesthesiologist with information on the pathophysiology, physiology, and management of patients with sickle cell disease. This includes the evaluation of common intraoperative management issues as well as perioperative concerns related to the disease. This review will also discuss the outpatient care of sickle cell patients concerning disease-modifying agents and chronic pain management. ⋯ The sociopolitical context and pathophysiology of sickle cell disease make it a unique disease to manage for the practicing anesthesiologist. Tailoring management via developing a patient-specific approach to maintain homeostasis and minimize the perioperative prevalence of VOCs.
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Curr Opin Anaesthesiol · Feb 2025
Restoring hemostasis with prothrombin complex concentrate: benefits and risks in trauma-induced coagulopathy.
To provide evidence for the use of prothrombin complex concentrate (PCC) as a potential hemostatic treatment for trauma-induced coagulopathy with and without anticoagulants. ⋯ PCC is a valuable option for managing coagulopathy in specific settings, especially VKA and DOAC reversal. Based on current evidence, we caution against the use of PCC as a versatile hemostatic agent suitable for indications involving multiple clotting factor deficiencies for uncontrolled coagulopathic bleeding in trauma or other clinical settings outside anticoagulation reversal. The risk vs. benefit profile should be carefully examined, similar to any other agent.
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Curr Opin Anaesthesiol · Feb 2025
REBOA for remote damage control resuscitation and the race against time.
The management of noncompressible haemorrhage (NCH) remains a critical challenge in trauma care, with early mortality rates persistently high despite advances in trauma systems. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a potential intervention to address severe haemorrhage in prehospital and hospital settings. This review examines the role of REBOA in remote damage control resuscitation, focusing on the 'golden hour' and the 'platinum 5 minutes' concepts that underscore the urgency of timely interventions. ⋯ The integration of REBOA with advanced prehospital strategies holds the potential for reducing preventable deaths from traumatic haemorrhage, but further research is needed to refine protocols and enhance outcomes in this high-stakes domain.