Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2025
ReviewPerioperative management of patients with mediastinal mass syndrome.
The mediastinal mass syndrome (MMS) can occur after induction of anesthesia, intraoperatively or even days after the surgical procedure. The focus of this review is on the management of pediatric and adult patients with a significant mediastinal mass. ⋯ Meticulous planning, implementation of anesthetic management protocols and protocols for emergency situations are essential to guarantee patient safety with a mediastinal mass.
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Curr Opin Anaesthesiol · Feb 2025
ReviewPreventing, identifying and managing myocardial injury after non cardiac surgery - a narrative review.
There is mounting and convincing evidence that patients with postoperative troponin elevation, with or without any clinical symptoms, are at higher risk for both, short- and long-term morbidity and mortality. Myocardial injury after noncardiac surgery (MINS) is a relatively newly described syndrome, and the pathogenesis is not fully understood yet. MINS is now an established syndrome and multiple guidelines address potential etiologies, triggers, as well as preventive and management strategies. ⋯ MINS affects up to 20% of surgical patients, remains clinically mostly silent, but is associated with elevated morbidity and mortality. A multidisciplinary approach, that includes involvement of anesthesiologists, for the prevention, diagnosis, and treatment of MINS is recommended.
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Curr Opin Anaesthesiol · Feb 2025
ReviewThe climate crisis - actions to prioritize for anaesthesiologists.
Climate change is the biggest threat to human health and survival in the twenty-first century. Emissions associated with healthcare contribute to climate change and there are many personal and professional actions that can reduce carbon emissions. This review highlights why action is necessary and what anaesthetists and healthcare workers can do. ⋯ This article shows that, while patient safety and quality of care must remain healthcare's top priority, considering the climate implications of care is part of that duty. Many actions that reduce the carbon impact of care simultaneously improve the quality of care and reduce financial cost. More research into sustainable healthcare is needed. Departments and hospitals and must create environments in which climate conversations are welcomed and can result in positive advancements.
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Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery. ⋯ This paper reviews advancements in perioperative pain management for cardiac surgery patients, emphasising the shift from high-dose opioids to multimodal analgesia and regional anaesthetic techniques, and highlighting the role of multidisciplinary transitional pain services.
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Curr Opin Anaesthesiol · Feb 2025
ReviewThe autonomous nervous system and the cholinergic anti-inflammatory reflex in postoperative neurocognitive disorders.
Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with postoperative neurocognitive disorder (PNCD). The vagal cholinergic anti-inflammatory pathway (CAP) has been hypothesized to play a role in POD/PNCD and may be a target for interventions such as transcutaneous auricular stimulation (taVNS). We aim to review associations of heart rate variability (HRV) as an indicator of vagal function with POD and postoperative immune reaction as well as taVNS as a potential preventive intervention for POD. ⋯ Our review provides no evidence that CAP suppression is associated with POD/PNCD. Future studies should consider that high vagal tone may also mediate immunosuppression in surgical patients, yielding an increased risk for postoperative infections. Although taVNS is a promising approach to prevent POD/POCD, future studies should take these concerns into account.