Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2024
ReviewCurrent concepts and targets for preventing the transition of acute to chronic postsurgical pain.
It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact. ⋯ A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.
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Curr Opin Anaesthesiol · Oct 2024
ReviewPostoperative pain management after thoracic transplantations.
Heart and lung transplantation evolution marked significant milestones. Pioneering efforts of Dr Christiaan Barnard with the first successful heart transplant in 1967, followed by advancements in heart-lung and single-lung transplants by Drs Bruce Reitz, Norman Shumway, and Joel Cooper laid the groundwork for contemporary organ transplantation, offering hope for patients with end-stage heart and pulmonary diseases. ⋯ This review emphasizes the importance of tailored pain management in heart and lung transplant recipients. It advocates for extended follow-up and alternative analgesics to minimize opioid dependency and enhance quality of life. Further high-quality research is needed to optimize postoperative analgesia and improve patient outcomes.
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Curr Opin Anaesthesiol · Oct 2024
ReviewHarnessing artificial intelligence for predicting and managing postoperative pain: a narrative literature review.
This review examines recent research on artificial intelligence focusing on machine learning (ML) models for predicting postoperative pain outcomes. We also identify technical, ethical, and practical hurdles that demand continued investigation and research. ⋯ Artificial intelligence (AI) has the potential to enhance perioperative pain management by providing more accurate predictive models and personalized interventions. By leveraging ML algorithms, clinicians can better identify at-risk patients and tailor treatment strategies accordingly. However, successful implementation needs to address challenges in data quality, algorithmic complexity, and ethical and practical considerations. Future research should focus on validating AI-driven interventions in clinical practice and fostering interdisciplinary collaboration to advance perioperative care.
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Curr Opin Anaesthesiol · Oct 2024
ReviewKeeping patients in the dark: perioperative anesthetic considerations for patients receiving 5-aminolevulinic acid for glioma resection.
5-Aminolevulinic acid hydrochloride (5-ALA), available under the trade name Gleolan, is an orally administered fluorophore drug used to enhance visual differentiation of cancerous tissue from healthy tissue, primarily during surgical resection of high-grade gliomas. Although given preoperatively, 5-ALA has important implications for anesthetic care throughout the perioperative period. This article reviews pharmacology, safety concerns, and perioperative considerations for patients who receive oral 5-ALA. ⋯ Mitigating the possible side effects of 5-ALA requires an understanding of its basic mechanism as well as focused perioperative planning and communication. Administration of this medication may result in nausea, vomiting, photosensitivity, increase in serum concentration of liver enzymes, and hypotension. Patients who receive 5-ALA must be protected from prolonged light exposure during the first 48 h after consumption and administration of other photosensitizing agents should be avoided (Supplemental Video File/Video abstract).
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Curr Opin Anaesthesiol · Oct 2024
ReviewOptimizing peripheral regional anaesthesia: strategies for single shot and continuous blocks.
Regional anaesthesia is increasingly prominent within anaesthesia, offering alternative analgesic options amidst concerns over opioid-based analgesia. Since Halsted's initial description, the field has burgeoned, with ultrasound visualization revolutionizing local anaesthetic spread assessment, leading to the development of numerous novel techniques. The benefits of regional anaesthesia have gained increasing evidence to support their application, leading to changes within training curricula. Consequently, regional anaesthesia is at a defining moment, embracing the development of core skills for the general anaesthesiologist, whilst also continuing the advancement of the specialty. ⋯ This review highlights recent scientific advances in optimizing both single-shot and continuous peripheral regional anaesthesia techniques. By synthesizing these developments, this review offers valuable insights into the evolving landscape of regional anaesthesia, aiming to improve clinical practice and patient care.