Articles: cations.
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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
Integrating regional blocks into Enhanced Recovery After Surgery protocols for cesarean delivery: optimizing postoperative recovery.
This review aims to synthesize the current literature on the use of regional blocks to enhance and optimize postoperative recovery after cesarean delivery, highlighting key strategies, challenges, and emerging trends. ⋯ Managing pain after cesarean delivery continues to pose a significant challenge. The overall prevalence of acute postoperative pain remains high (58%) and, even when strict adherence to established guidelines is ensured, approximately 25% of patients report inadequate pain control. Within a multimodal analgesic framework, when neuraxial morphine - still considered the gold standard - is not an option, the use of peripheral nerve and fascial plane blocks has demonstrated clear benefits. Recent literature suggests that quadratus lumborum block may serve as a promising alternative to intrathecal morphine for women who cannot tolerate opioids. Additionally, incorporating certain regional techniques alongside neuraxial morphine may further improve postoperative analgesia, especially for patients at high risk of severe postoperative pain and those who have contraindications to other analgesic modalities.
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Critical care medicine · Feb 2025
Host Response Stratification in Malarial and Non-malarial Sepsis: A Prospective, Multicenter Analysis From Uganda.
Globally, the burden of sepsis is highest in malaria endemic areas of sub-Saharan Africa. The influence of malaria on biological heterogeneity inherent to sepsis in this setting is poorly understood. We sought to determine shared and distinct features of the host response in malarial and non-malarial sepsis in sub-Saharan Africa. ⋯ Host responses are largely conserved in malarial and non-malarial sepsis but may be distinguished by a signature of relative immunosuppression in the former. Further investigations are needed to differentiate mechanisms of malarial and non-malarial sepsis, with the goal of informing pathogen-stratified and pathogen-agnostic treatment strategies.