Current opinion in anaesthesiology
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To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations. ⋯ Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma and strive to maintain cerebral homeostasis in the perianesthetic period.
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Curr Opin Anaesthesiol · Oct 2020
ReviewDiaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemic.
Given that COVID-19 can severely impair lung function, regional anesthesia techniques avoiding phrenic nerve paralysis are relevant in the anesthetic management of suspected/confirmed COVID-19 patients requiring shoulder and clavicle surgical procedures. The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise. ⋯ Existing diaphragm-sparing brachial plexus regional anesthesia techniques used for shoulder and clavicle surgery may help minimize pulmonary complications by preserving lung function, especially in patients prone to respiratory compromise. Used as an anesthetic technique, they can reduce the risk of exposure of healthcare teams to aerosol-generating medical procedures (AGMPs), albeit posing an increased risk for hemi-diaphragmatic paralysis. Reducing the incidence of phrenic nerve involvement and obtaining opioid-sparing analgesia without jeopardizing efficacy should be prioritized goals of regional anesthesia practice during the COVID-19 pandemic.
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Curr Opin Anaesthesiol · Oct 2020
ReviewEducation and training in ultrasound-guided regional anaesthesia and pain medicine.
Effective and safe regional anaesthesia and pain medicine procedures require clinicians to learn and master complex theoretical knowledge and motor skills. This review aims to summarize articles relevant to education and training in these skill sets in the previous 2 years. ⋯ Research into education and training in regional anaesthesia covered multiple and diverse topics. Methodological limitations were noted in several articles, reflecting the difficulties in designing and conducting medical education studies. Nonetheless, the evidence-base continues to mature and innovations provide exciting future possibilities.
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Curr Opin Anaesthesiol · Oct 2020
ReviewDouble standards: why is pulse oximetry standard care, whereas tissue oximetry is not?
Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment? ⋯ Pulse oximetry and tissue oximetry are treated differently although neither monitor has robust evidence attesting to its outcome benefits. This difference may root in the difference in the physiology they monitor, the cost, the ease of use/interpretation/intervention and the relevance to patient safety and care quality. Pulse oxygen saturation represents a vital sign, whereas tissue oxygen saturation is likely a quality sign; however, further research endeavors are required to fully understand how to best use tissue oximetry.
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Curr Opin Anaesthesiol · Oct 2020
ReviewPostoperative delirium: why, what, and how to confront it at your institution.
The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions. ⋯ POD continues to be a serious perioperative complication commonly experienced by older adults. Growing appreciation of its prognostic implications and evidence behind multidisciplinary, collaborative, and focused prevention strategies rooted in implementation science have prompted several major groups to issue consensus guidelines. Adopting best practices POD risk stratification and prevention pathways will improve perioperative care for older adults.