Current opinion in anaesthesiology
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Anesthetics are known to have immunomodulatory effects. These can be detrimental, inducing immunosuppression and facilitating the development of opportunistic infections, especially when used at high doses, for prolonged periods, or in patients with preexisting immune deficiency; or beneficial, modulating the inflammatory response, particularly in critical illness and systemic hyperinflammatory states. ⋯ Anesthesiologists should take into consideration the immunomodulatory properties of anesthetic agents in addition to their hemodynamic, neuroprotective, and other impacts. In future, patient stratification according to the perioperative assessment of serum biomarkers associated with postoperative complications may be used to guide anesthetic agent selection based on their immunomodulatory properties.
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Opioid use disorder (OUD) in pregnancy has more than quadrupled in prevalence over the past two decades and continues to increase steadily every year. With no defined standard of care for the management of pain during the peripartum period, variability in treatment plans potentially leaves room for interrupted patient care, decreased patient satisfaction, and poorer outcomes. The impact of OUD and its management during the peripartum period has become more widely discussed over the past several years and is the focus of this review. ⋯ This review will address both pain management recommendations and best clinical practices regarding management of the parturient during the transition periods of the peripartum, intrapartum, and postpartum period. Novel approaches and perspectives from case reports and narrative experience will also be discussed. There are many opportunities in this field for further studies, research, and evidence-based guidelines that promote an established standard of care.
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An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients. ⋯ Endocrine disorders will commonly present in the perioperative time period and the anesthesiologist plays a critical role in achieving good operative outcomes.
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Curr Opin Anaesthesiol · Jun 2021
ReviewCurrent concepts in the evaluation and management of preoperative anemia.
In the past years, patient blood management (PBM) has evolved to improve patient's care and safety. Anemia is one of the most common medical diseases in the world and is an independent risk factor for morbidity and mortality. Iron deficiency is the main cause for anemia and constitutes a potentially preventable condition with a great impact on surgical outcome. However, preoperative anemia management is not yet established in most hospitals. Changing workflows and re-thinking is challenging. Numerous published studies confirmed the positive effect of preoperative anemia diagnosis and treatment recently. ⋯ Since the introduction of PBM programs, important movements towards early detection and therapy of preoperative anemia have been observed. However, preoperative anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Preoperative anemia management, particularly iron supplementation in IDA patients, has proven to be highly effective and has a tremendous effect on patient safety and outcome.