Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2015
ReviewCommon procedures and strategies for anaesthesia in interventional radiology.
This review describes the range of cases now available in the interventional radiology suite and summarizes suggestions for their anaesthetic and perioperative management. ⋯ Cases in interventional radiology are complex in terms of the logistics of working in an unfamiliar area, frequency of patient comorbidity and unfamiliar procedures. Ensuring familiarity with the variety of interventional radiology procedures and their periprocedure requirements can increase anaesthesiologists' comfort in interventional radiology.
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Curr Opin Anaesthesiol · Aug 2015
ReviewAnalgesic management of acute pain in the opioid-tolerant patient.
The management of acute pain in the opioid-tolerant patient is an area in perioperative medicine that is growing, as the use of opioids for chronic noncancer pain has been tolerated in the USA. Adding to this population is an increase in opioid abusers, addicts and those in recovery and maintenance programmes. These patients will continue to present for surgery and with acute pain that anaesthesiologists and other members of the healthcare team must become more adept at managing. ⋯ There is a need for more high-level evidence-based guidelines to help practitioners achieve the best care of this growing high-risk population of patients.
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Curr Opin Anaesthesiol · Aug 2015
ReviewPreprocedural evaluation: considerations outside of the operating room.
There are an increasing number of procedures performed in locations outside of the operating room both for children and adults. From the perspective of the anesthesiologist, the preprocedural evaluation is essential in providing safe and high-quality care. This review focuses on the purpose, considerations and methods for providing information during the preprocedural evaluation process based on the most recent literature review. ⋯ It is important for the anesthesia provider to perform a thorough preprocedural evaluation. Tests that are ordered as part of the evaluation are done to understand the current medical state, verify a condition or formulate a plan. Informed consent must be obtained and the risks and benefits of the anesthesia plan in a manner understandable to the patient and parent or care giver.Many pediatric patients undergoing procedures outside of the operating room are in good health, and their evaluation will be relatively routine. Other children will present with complex medical conditions that require more time for the evaluation process. This may include the consultation of a pediatric specialist(s) as a necessary step toward completion of the preprocedural evaluation.Similarly, there are adult patients undergoing procedures outside of the operating room, which will have a straightforward preprocedural evaluation and others are more complex. Disease states that might require further testing include diabetes, leukemia, kidney and liver disease, central nervous system disease, malabsorption syndrome, coronary artery disease, coagulopathies and patients on diuretics.
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This review summarizes recent progress in the development of new muscle relaxants that are inactivated by cysteine, and considers the evolving paradigm of selective relaxant binding or degrading agents that can reverse neuromuscular blockade at any time. ⋯ The gantacurium derivative CW002 is an intermediate duration, nondepolarizing, cysteine-inactivated, neuromuscular blocking drug currently in clinical trials. Like sugammadex reversal of rocuronium, CW002 can be reversed at any time by cysteine injection.
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Acute kidney injury (AKI) is a common and serious complication that significantly increases morbidity, mortality, and cost of care after surgery. In this article, we review recent studies that deal with strategies for renal protection and the prevention of AKI after surgery. ⋯ Early identification of patients at risk for AKI is crucial to apply any protective intervention. An improved perioperative management is required to prevent AKI. Although pharmacological therapies aiming to protect AKI are under evaluation, hemodynamic optimization and avoidance of nephrotoxic drugs are critical for perioperative patient.