Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2021
ReviewSelective periarticular blocks for postoperative pain after hip and knee arthroplasty.
This review aims to provide an overview of selective periarticular blocks for postoperative pain after hip and knee arthroplasty and the current evidence for their use. ⋯ The pericapsular blocks of the hip (pericapsular nerve group block, iliopsoas plane block, hip block), genicular nerves block, and infiltration between the popliteal artery and the capsule of the knee play an increasingly important role in providing postoperative analgesia after hip and knee arthroplasty without impeding fast-track protocols.
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Curr Opin Anaesthesiol · Aug 2021
ReviewReady for a "breakthrough" with ketamine? A look at recent pharmacological insights!
To update pharmacological insights on ketamine integrating information from different disciplines for developing steps to "breakthrough" approaches in clinical challenges. ⋯ More precise PK/PD models may improve the ketamine use regimen. The findings from research on depression are an important discovery because ketamine's impact on neuronal plasticity and synaptogenesis in human brain disease has directly been documented. Psychic adverse effects with subanesthetic ketamine are related to a "disconnected consciousness". Overall, progress has been made, but the "breakthrough" still has to come.
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Curr Opin Anaesthesiol · Aug 2021
ReviewAnesthetic Management of Acute Ischemic Stroke in the Interventional Neuro-Radiology Suite: State of the Art.
This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke. ⋯ Optimal time to intervention, hemodynamic stability, novel imaging techniques, and careful consideration of anesthetic plan can impact patient outcomes in reperfusion stroke therapy.
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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.