Current opinion in anaesthesiology
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Chronic obstructive pulmonary disease affects more than 65 million people worldwide. Lung transplantation is the only definitive treatment. However, donor availability is limited in meeting the demand. ⋯ The lung's ability to regenerate extensively after injury suggests that this capability could be promoted in diseases in which loss of lung tissue occurs. Lung bioengineering offers the potential to drastically extend life expectancy in patients with end-stage lung disease. If lung reengineering were successful, it would revolutionize the world of transplantation.
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Curr Opin Anaesthesiol · Feb 2025
ReviewPerioperative risk scores: prediction, pitfalls, and progress.
Perioperative risk scores aim to risk-stratify patients to guide their evaluation and management. Several scores are established in clinical practice, but often do not generalize well to new data and require ongoing updates to improve their reliability. Recent advances in machine learning have the potential to handle multidimensional data and associated interactions, however their clinical utility has yet to be consistently demonstrated. In this review, we introduce key model performance metrics, highlight pitfalls in model development, and examine current perioperative risk scores, their limitations, and future directions in risk modelling. ⋯ All perioperative risk scores have some limitations, highlighting the need for robust model development and validation. Advancements in machine learning present promising opportunities to enhance this field, particularly through the integration of diverse data sources that may improve predictive performance. Future work should focus on improving model interpretability and incorporating continuous learning mechanisms to increase their clinical utility.
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Curr Opin Anaesthesiol · Feb 2025
ReviewPerioperative management of patients with mediastinal mass syndrome.
The mediastinal mass syndrome (MMS) can occur after induction of anesthesia, intraoperatively or even days after the surgical procedure. The focus of this review is on the management of pediatric and adult patients with a significant mediastinal mass. ⋯ Meticulous planning, implementation of anesthetic management protocols and protocols for emergency situations are essential to guarantee patient safety with a mediastinal mass.
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Curr Opin Anaesthesiol · Feb 2025
ReviewNonintubated video-assisted thoracic surgery: myth or reality?
This review discusses nonintubated video-assisted thoracic surgery (NIVATS) by presenting its physiological, technical aspects and recent clinical data from the literature. ⋯ Literature has demonstrated the feasibility of NIVATS and suggest that it can improve patient outcomes. High-quality international randomized multicenter studies comparing NIVATS and intubated video-assisted thoracic surgery are necessary for a strong comprehension to clarify whether it can be a technique that can guarantee safety and improve the perioperative course of patients.
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Curr Opin Anaesthesiol · Feb 2025
ReviewThe autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders.
Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with postoperative neurocognitive disorder (PNCD). The vagal cholinergic anti-inflammatory pathway (CAP) has been hypothesized to play a role in POD/PNCD and may be a target for interventions such as transcutaneous auricular stimulation (taVNS). We aim to review associations of heart rate variability (HRV) as an indicator of vagal function with POD and postoperative immune reaction as well as taVNS as a potential preventive intervention for POD. ⋯ Our review provides no evidence that CAP suppression is associated with POD/PNCD. Future studies should consider that high vagal tone may also mediate immunosuppression in surgical patients, yielding an increased risk for postoperative infections. Although taVNS is a promising approach to prevent POD/POCD, future studies should take these concerns into account.