Current opinion in anaesthesiology
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Ketamine has been used for decades for a variety of indications. Beyond the historical benefits and effects of ketamine, newer developments have occurred worthy of an update. This review will discuss common uses and indications for ketamine in the perioperative setting, as well as highlight newer indications in recent years. ⋯ Ketamine is regaining popularity in the field of anesthesia and beyond. New studies provide insight on the many indications and use that anesthesia providers may encounter during their perioperative care of patients. Ongoing research is needed to further elucidate ketamine's effects on the management of psychiatric conditions and potential indications for ketamine metabolites.
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Curr Opin Anaesthesiol · Oct 2020
ReviewHas the future arrived? Liposomal bupivacaine versus perineural catheters and additives for interscalene brachial plexus block.
Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself. ⋯ Interscalene catheters, adjunctive drugs added to local anesthetics in single-injection interscalene brachial plexus blocks, or liposomal bupivacaine may be used to effectively prolong the duration of analgesia for shoulder surgery patients.
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Curr Opin Anaesthesiol · Oct 2020
ReviewInterventions to improve perioperative neurologic outcomes.
Few outcomes in surgery are as important to patients as that of their neurologic status. The purpose of this review is to discuss and categorize the most common perioperative neurologic complications. We will also discuss strategies to help prevent and mitigate these complications for our patients. ⋯ A thorough understanding of threats to patients' neurologic well-being is essential to excellent clinical practice.
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Curr Opin Anaesthesiol · Oct 2020
Prospects of molecular hydrogen in perioperative neuroprotection from basic research to clinical application.
The current systematic review summarizes recent, basic clinical achievements regarding the neuroprotective effects of molecular hydrogen in distinct central nervous system conditions. ⋯ Fundamental and clinical evidence supports the antioxidant, antiinflammation, antiapoptosis and mitochondrial protective effects of hydrogen in the pathophysiology of nervous system diseases. The clinically preventive and therapeutic effects of hydrogen on different neural diseases, however, remain uncertain, and the lack of support by large randomized controlled trials has delayed its clinical application.
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Curr Opin Anaesthesiol · Oct 2020
ReviewDouble standard: why electrocardiogram is standard care while electroencephalogram is not?
A compelling argument that the EEG and it's derivative monitors should be 'standard of care' during anaesthesia, contrasting this with the ECG, arguably a less useful, actionable or meaningful monitor, yet has been widely considered a routine monitor for three decades.
The authors' main thesis is that:
- Intraoperative EEG accurately monitors anaesthetic depth.
- Using EEG to guide intraoperative depth may reduce both anaesthetic use and postoperative delirium.
- Reducing drug exposure and depth of anaesthesia probably has significant patient and societal benefits.
- All anaesthetists and anesthesiologists should be familiar with interpreting the raw EEG in the context of anaesthesia.
However...
- While postoperative delirium is common in the over 65y age group (15-20%) and is associated with adverse outcomes, it is less clear that avoiding excessive depth reliably reduces postoperative delirium (some studies say yes, others...)
- Additionally, because post-op delirium is often used as (or at least inadvertently becomes) a surrogate marker for a range of adverse post-op events, then it follows that EEG monitoring should also be associated with reducing these events. This has not yet been shown.