Current opinion in anaesthesiology
-
Opioid use disorder (OUD) in pregnancy has more than quadrupled in prevalence over the past two decades and continues to increase steadily every year. With no defined standard of care for the management of pain during the peripartum period, variability in treatment plans potentially leaves room for interrupted patient care, decreased patient satisfaction, and poorer outcomes. The impact of OUD and its management during the peripartum period has become more widely discussed over the past several years and is the focus of this review. ⋯ This review will address both pain management recommendations and best clinical practices regarding management of the parturient during the transition periods of the peripartum, intrapartum, and postpartum period. Novel approaches and perspectives from case reports and narrative experience will also be discussed. There are many opportunities in this field for further studies, research, and evidence-based guidelines that promote an established standard of care.
-
Pregnancy exacerbates sickle cell disease (SCD) and is associated with increased frequency and severity of complications resulting in high levels of maternal and fetal morbidity and mortality. We review recent recommendations for managing SCD in pregnancy. ⋯ Patients should be managed by a multidisciplinary and experienced team. The perioperative episode is a recognized period of disease exacerbation and informed anesthetic management can contribute to improved patient outcomes.
-
Curr Opin Anaesthesiol · Jun 2021
ReviewThe disruptive physician and impact on the culture of safety.
The disruptive physician is a growing problem in medicine. All too often, physician behavior negatively impacts the delivery of quality patient care. The hostile environment that certain behaviors create makes it difficult for team members advocate for their patients. It is imperative that physician practices develop and an understanding of how to identify the disruptive physician to maintain patient safety. ⋯ The practice of medicine is multifaceted. It is imperative that the assurance of psychological safety is met to meet the standards of high quality and safe care for patients.
-
Curr Opin Anaesthesiol · Jun 2021
ReviewHow new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury.
Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evidence and explain why timely perioperative management does have impact on the development of AKI and overall outcomes for patients. ⋯ AKI is a time critical syndrome that requires timely detection and damage biomarkers can help to adjust the perioperative management to prevent further injury.
-
An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients. ⋯ Endocrine disorders will commonly present in the perioperative time period and the anesthesiologist plays a critical role in achieving good operative outcomes.