Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2019
ReviewThe impact of frailty and sarcopenia on patient outcomes after complex spine surgery.
Frailty and sarcopenia represent a state of increased fragility and decreased reserve, and both have been associated with worse outcomes after surgery. The present review focuses on the definitions and measurement tools used to assess frailty and sarcopenia in patients with spinal disorder, and the relationships between frailty, sarcopenia, and postoperative outcomes in patients undergoing complex spine surgery. ⋯ Frailty and sarcopenia are increasingly recognized as important predictors of adverse outcomes after complex spine surgery. The optimal tool to measure frailty and sarcopenia in patients with spinal disorders remains unclear, and the role of surgery as an intervention to reverse frailty requires further investigation.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewNeurological complications after cardiac surgery: anesthetic considerations based on outcome evidence.
Neurological complications after cardiac surgery remain prevalent. This review aims to discuss the modifiable and outcome-relevant risk factors based on an up-to-date literature review, with a focus on interventions that may improve outcomes. ⋯ The available evidence highlights the importance of maintaining optimal and individualized blood pressure, cerebral tissue oxygen saturation and hemoglobin level in improving neurological outcomes after cardiac surgery. However, outstanding issues remain and need to be addressed via outcome-oriented further research.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewRegional anesthesia for vascular surgery: does the anesthetic choice influence outcome?
Outcomes following surgery are of major importance to clinicians, institutions and most importantly patients. This review examines whether regional anesthesia and analgesia influence outcome after vascular surgery. ⋯ Patients undergoing vascular surgery often have multiple comorbidities and it is important to be able to outline both benefits and risks of regional anesthesia techniques. Regional anesthesia in vascular surgery allows avoidance of general anesthesia and does provide short-term benefits beyond superior analgesia. Evidence of long-term benefits is lacking in most procedures. Further work is required on newer patient centered outcomes.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewAnesthetic management of complex spine surgery in adult patients: a review based on outcome evidence.
The aim of this article is to review the evidence regarding the anesthetic management of blood loss, pain control, and position-related complications of adult patients undergoing complex spine procedures. ⋯ As the number and complexity of spine procedures are being performed worldwide is increasing, we suggested to bundle the aforementioned effective interventions as part of an ERAS spine protocol to improve the patient outcome of spine surgery.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewPatient-reported outcome measures for acute and chronic pain: current knowledge and future directions.
During the past years, patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) have become of growing awareness and importance in medical research and practice. This review summarizes recent developments concerning PROs and PROMs related to pain in the acute postoperative as well as chronic settings and indicates gaps and challenges relevant for future research and clinical applications. ⋯ COSs of PRO and PROMs are crucial in the field of research to enhance the comparability of results and reducing outcome reporting bias. In clinical practice PROs and PROMs are important for allocation of treatment. Concerning the development and implementation of PROs and PROMs patients' perspective should be thoroughly considered. Relating to acute as well as chronic pain there are some attempts to create COSs of PROs and PROMs but validity and reliability for both are still missing.