Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2023
ReviewThe green anaesthesia dilemma: to which extent is it important to preserve as many drugs available as possible.
This article aims to summarize the current literature describing the availability of different anaesthetic drugs, and to discuss the advantages and limitations of a self-imposed restriction on the scarcely existing anaesthetic drugs. ⋯ There are just a handful number of available anaesthetics that provide for a safe hypnosis. Major stakeholders should be consulted prior making such severe decisions that affect patient safety.
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Do-not-intubate (DNI) orders are more frequently encountered over time. This widespread diffusion of DNI orders make it essential to develop therapeutic strategies matching patient's and his family willingness. The present review sheds light on the therapeutic approaches employed to support respiratory function of patients with DNI orders. ⋯ In dealing with DNI patients, the individualization of treatments is of pivotal importance to respect patient's preferences and improve quality of life at the same time.
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Curr Opin Anaesthesiol · Apr 2023
ReviewPediatric trauma center vs. adult trauma center: which is better?
Pediatric trauma centers (PTCs) have been championed as multidisciplinary facilities specializing in the care of pediatric trauma, the leading cause of childhood mortality in the United States. 1 However, the vast majority of pediatric trauma is still seen in trauma centers focused on treating adults. This article reviews the latest evidence comparing the relative strengths of PTCs and adult trauma centers (ATCs) in treating childhood injury. ⋯ It is difficult to demonstrate a difference in outcomes for children treated at PTCs vs. ATCs. However, PTCs do offer a multidisciplinary, nuanced approach to pediatric trauma care, which may result in long term benefits and offer opportunities for regional collaboration.
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Hemorrhage and trauma-induced coagulopathy cause significant morbidity and mortality in trauma patients. Although blood products are the cornerstone of resuscitation, these resources are scarce, necessitating alternatives. This review examines the use of alternative blood products in trauma as well as the literature supporting their use. ⋯ Stabilization of hemorrhage and resuscitation is priority in trauma-induced coagulopathy treatment. Alternative products such as tranexamic acid, recombinant factors, prothrombic complex concentrate, fibrinogen concentrates, and desmopressin may also be considered based on the clinical context. Viscoelastic hemostatic assays such as rotational thromboelastometry and thromboelastography can help guide these efforts. Following initial stabilization, additional interventions such as iron supplementation, erythropoietin stimulating agents, and vitamin D may help with chronic sequela.
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The coronavirus disease 2019 pandemic and recent global recessions have brought to the forefront of the medical-political discussion the fact that medical resources are finite and have focused a spotlight on fair allocation and prioritization of healthcare resources describe why this review is timely and relevant. ⋯ Models for resource allocation must differentiate between different types of resources, some of which may require early preparation or distribution. Local availability of specific resources, supplies and infrastructure must be taken into consideration during preparation. When planning for long durations of limited resource availability, the limitations of human resilience must also be considered. Preparation also requires information regarding the needs of the specific population at hand (e.g. age distributions, disease prevalence) and societal preferences must be acknowledged within possible limits.