Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2025
Restoring hemostasis with prothrombin complex concentrate: benefits and risks in trauma-induced coagulopathy.
To provide evidence for the use of prothrombin complex concentrate (PCC) as a potential hemostatic treatment for trauma-induced coagulopathy with and without anticoagulants. ⋯ PCC is a valuable option for managing coagulopathy in specific settings, especially VKA and DOAC reversal. Based on current evidence, we caution against the use of PCC as a versatile hemostatic agent suitable for indications involving multiple clotting factor deficiencies for uncontrolled coagulopathic bleeding in trauma or other clinical settings outside anticoagulation reversal. The risk vs. benefit profile should be carefully examined, similar to any other agent.
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Curr Opin Anaesthesiol · Feb 2025
REBOA for remote damage control resuscitation and the race against time.
The management of noncompressible haemorrhage (NCH) remains a critical challenge in trauma care, with early mortality rates persistently high despite advances in trauma systems. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a potential intervention to address severe haemorrhage in prehospital and hospital settings. This review examines the role of REBOA in remote damage control resuscitation, focusing on the 'golden hour' and the 'platinum 5 minutes' concepts that underscore the urgency of timely interventions. ⋯ The integration of REBOA with advanced prehospital strategies holds the potential for reducing preventable deaths from traumatic haemorrhage, but further research is needed to refine protocols and enhance outcomes in this high-stakes domain.
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Curr Opin Anaesthesiol · Feb 2025
Advances in neonatal resuscitation for the obstetric anesthesiologist.
This review provides an updated overview of neonatal resuscitation practices relevant to obstetric anesthesiologists, with a focus on term and late preterm neonates (>34 weeks' gestation). Key topics include umbilical cord management, temperature regulation, airway strategies, and pharmacological interventions, emphasizing evidence-based approaches. ⋯ Recent advancements in neonatal resuscitation focus on precision in ventilation, thermoregulation, and airway management. Obstetric anesthesiologists play a critical role in neonatal emergencies, underscoring the need for continuous training and the integration of emerging technologies like artificial intelligence to optimize neonatal outcomes.
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Curr Opin Anaesthesiol · Feb 2025
Integrating regional blocks into Enhanced Recovery After Surgery protocols for cesarean delivery: optimizing postoperative recovery.
This review aims to synthesize the current literature on the use of regional blocks to enhance and optimize postoperative recovery after cesarean delivery, highlighting key strategies, challenges, and emerging trends. ⋯ Managing pain after cesarean delivery continues to pose a significant challenge. The overall prevalence of acute postoperative pain remains high (58%) and, even when strict adherence to established guidelines is ensured, approximately 25% of patients report inadequate pain control. Within a multimodal analgesic framework, when neuraxial morphine - still considered the gold standard - is not an option, the use of peripheral nerve and fascial plane blocks has demonstrated clear benefits. Recent literature suggests that quadratus lumborum block may serve as a promising alternative to intrathecal morphine for women who cannot tolerate opioids. Additionally, incorporating certain regional techniques alongside neuraxial morphine may further improve postoperative analgesia, especially for patients at high risk of severe postoperative pain and those who have contraindications to other analgesic modalities.
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Thoracic injuries are directly responsible for 20-30% of deaths in severe trauma patients and represent one of the main regions involved in preventable or potentially preventable deaths. Controlling bleeding in thoracic trauma is a major challenge because intrathoracic hemorrhagic lesions can lead to hemodynamic instability and respiratory failure. ⋯ Thoracic bleeding can result from the diaphragm, intrathoracic vessels (aorta, but also inferior or superior vena cava, and suprahepatic veins), lung, cardiac, or chest wall injuries. Depending on thoracic lesions (such as hemothorax or hemopericardium), hemodynamic instability, and respiratory failure, a pericardial window approach, sternotomy, thoracotomy, or emergency resuscitation thoracotomy may be considered after discussion with the surgeon. Alongside treatment of injuries, managing oxygenation, ventilation, hemodynamic, and coagulopathy are essential for the patient's outcome.