Articles: operative.
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Anesthesia and analgesia · Apr 2022
Randomized Controlled TrialWound Infusion of 0.35% Levobupivacaine Reduces Mechanical Secondary Hyperalgesia and Opioid Consumption After Cesarean Delivery. A Prospective, Randomized, Triple-Blind, Placebo-Controlled Trial.
Post-caesarean section local anaesthetic wound infusion reduces acute postoperative pain & hyperalgesia although had no effect on persistent postoperative pain.
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Curr Opin Anaesthesiol · Apr 2022
ReviewA not so sweet scenario: impact of perioperative glucose control on regional anesthetic techniques for orthopedic surgery.
Diabetes and hyperglycemia are well established risk factors for complications associated with common orthopedic surgeries. In some practice settings, these conditions are also viewed as contraindications to regional nerve catheters. In this article, we aim to present our approach to offering the benefits of this modality in a safe manner for patients with diabetes and even some with preexisting, localized infections. ⋯ Based on our experience and reading of the literature, we advocate for a liberalized approach to use of continuous regional anesthesia for diabetic patients having for orthopedic surgery. A set of consensus guidelines tailored to institutions' resources and monitoring capabilities can be a useful tool for standardizing care. It may also increase access to the clinical benefits of this modality in a population particularly vulnerable to opioid related adverse effects.
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Anesthesia and analgesia · Apr 2022
Meta AnalysisA Systematic Review and Meta-Analysis Examining the Impact of Age on Perioperative Inflammatory Biomarkers.
Dysregulation of immune responses to surgical stress in older patients and those with frailty may manifest as differences in inflammatory biomarkers. We conducted a systematic review and meta-analysis to examine differences in perioperative inflammatory biomarkers between older and younger patients, and between patients with and without frailty. ⋯ Our findings demonstrate a paucity of frailty-specific studies; however, the presence of age-associated differences in the perioperative inflammatory response is consistent with age-associated states of chronic systemic inflammation and immunosenescence. Additional studies assessing frailty-specific changes in the systemic biologic response to surgery may inform the development of targeted interventions.
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The purpose of this review is to look at the current evidence on the consequences of intraoperative hypotension and discuss improvements that can be implemented for its prevention. ⋯ There should be a shift in paradigm in focusing on the prevention of intraoperative hypotension instead treatment. The suggested goals to help maintaining hemodynamic stability during anesthesia include ensure adequate blood pressure and flow; hypotension prevention; and ensure adequate anesthetic depth without overdose.
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Curr Opin Anaesthesiol · Apr 2022
ReviewReview of pediatric hypercarbia and intraoperative management.
Hypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. ⋯ Pediatric anesthesiologists and their teams must remain vigilant and anticipate these developments. Care must be taken to avoid any rapid changes in these vulnerable patients to minimize risks of adverse outcomes.