Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2021
ReviewRecent advances in understanding cognitive and behavioural alterations after early-in-life anaesthesia exposure and new mitigation/alternative strategies in preclinical studies.
Long-term behavioural and cognitive impairments after exposure to general anaesthetics during infancy is an intensely investigated and controversial topic. Recent clinical studies with prospective assessments associate exposure with long-term behavioural alterations rather than cognitive impairments. This review aims to provide an understanding of the long-term cognitive impairments and behavioural alterations found in recent animal studies and to summarize latest advances in strategies to protect against anaesthesia-induced developmental neurotoxicity (AIDN). ⋯ Recent findings in animal studies with translational relevance support the proposed association between early-in-life anaesthesia exposure and long-term alterations in behaviour. Studies aiming to prevent AIDN are promising and need evaluation in the NHP model. The careful design of subsequent translational studies will be critical to advance the field forward towards safer anaesthesia exposure in children.
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Curr Opin Anaesthesiol · Aug 2021
Review Meta AnalysisDrugs in anesthesia: preventing postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) continues to be a burden for patients, medical staff and healthcare facilities because of inadequate adherence to available recommendations. This review gives an overview on recent recommendations, new evidence and remaining issues in the field of PONV management. ⋯ Numerous drug (combinations) and strategies are available for PONV management. New and very effective (single) drugs could result in a simplification compared with a combination of several drugs, and thus lead to better implementation.
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Curr Opin Anaesthesiol · Aug 2021
ReviewAdvanced endoscopic gastrointestinal techniques for the bariatric patient: implications for the anesthesia provider.
The incidence of obesity and the use of endoscopy have risen concurrently throughout the 21st century. Bariatric patients may present to the endoscopy suite for primary treatments as well as preoperatively and postoperatively from bariatric surgery. However, over the past 10 years, endoscopic bariatric and metabolic therapies (EBMTs) have emerged as viable alternatives to more invasive surgical approaches for weight loss. ⋯ Obesity causes anatomic and physiologic changes to every aspect of the human body. All EBMTs have specific nuances with important implications for the anesthesiologist. By considering both patient and procedural factors, the anesthesiologist will be able to perform a safe and effective anesthetic.
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Curr Opin Anaesthesiol · Aug 2021
ReviewThe multisystem inflammatory syndrome in children and its association to SARS-CoV-2.
Multisystem inflammatory syndrome in children (MIS-C)/pediatric inflammatory multisystem syndrome (PIMS) is a new and serious disease that occurs in temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We describe the clinical presentation, diagnosis, and treatment recommendations. ⋯ MIS-C PIMS is a new syndrome that is associated with a variety of virus infections, and also with SARS-CoV-2. The main characteristics are fever, multiple organ dysfunction due to a hyper-inflammatory state. In particular, cardiac dysfunction and severe shock. A high proportion of patients require intensive medical care, but the absolute number of children with SARS-CoV-2 MIS-C is low. Medical therapy is based on pathophysiologic considerations and is not evidence-based. Immunoglobulins, steroids and biologics are used and lead to effective treatment. Therefore, the mortality rate is very low. Patients usually recover within days, sequelae are reported only in a minority of cases.
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Curr Opin Anaesthesiol · Aug 2021
ReviewModerate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice.
Interventional pain management procedures provide significant improvement to patient quality of life and functionality. In-office procedures are becoming an increasingly more common site of pain management intervention for patients with minimal risk of harm. ⋯ Serious complication errors can be avoided with proper supervision and monitoring. The adherence to published societal recommendations and guidelines for indications of when to use moderate to deep sedation techniques, and appropriate supervision and monitoring methods, can avoid errors in interventional pain management procedures.