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
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.
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Intraoperative hypotension (IOH) may render patients at a risk of cerebral hypoperfusion with decreasing cerebral blood flow (CBF), and lead to postoperative neurological injury. On the basis of the literature in recent years, this review attempts to refine the definition of IOH and evaluate its impact on neurological outcomes. ⋯ Despite the lack of a known threshold value, IOH is a modifiable risk factor targeted to improve neurological outcomes. Ideal BP management is recommended in order to maintain target BP based on the monitoring of rScO2 or cerebral pressure autoregulation.
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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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To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. ⋯ Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.