Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPrehabilitation before surgery: Is it for all patients?
To evaluate the role of prehabilitation interventions in adult patients before elective major surgery. ⋯ Studies evaluating multimodal prehabilitation interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical effectiveness is currently very limited. Future research should focus on refining interventions, exploring mechanisms, establishing minimum dosage, interrogating interactions between therapies, and urgent implementation of large-scale clinical effectiveness studies.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPrinciples for minimizing oxygen debt: can they translate to clinical application and improve outcomes?
Oxygen delivery is dependent on pulmonary gas exchange, cardiac output, blood oxygen-carrying capacity, and tissue oxygen extraction. Reduction in oxygen delivery or higher oxygen consumption can initiate complex protective cellular processes precipitating oxygen debt. In critically ill and potentially surgical patients, stress and consequent hormonal or metabolic changes can trigger oxygen debt which is associated with worse morbidity and mortality. ⋯ Furthermore, large heterogeneity in clinical trials assessing outcomes benefit of increasing oxygen delivery limits our ability to recommend goal directed fluid therapy aimed at increasing cardiac ouput or higher FiO2. To understand and prevent oxygen debt in critically ill and surgical patients, we need to develop continuous monitoring techniques to assess the balance of oxygen delivery and consumption. Furthermore, methods of increasing oxygen delivery like goal-directed fluid therapy, higher FiO2 and anemia prevention should be rigorously evaluated with focus on establishing outcomes benefit.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewApplication of perioperative hemodynamics today and potentials for tomorrow.
Hemodynamic (HD) monitoring remains integral to the assessment and management of perioperative and critical care patients. This review article seeks to provide an update on the different types of flow-guided HD monitoring technologies available, highlight their limitations, and review the therapies associated with the application of these technologies. Additionally, we will also comment on the expanding roles of HD monitoring in the future.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewAnesthetic care influences long-term outcomes: What is the evidence?
Despite advances in cancer therapy surgery remains one of the most important treatments for solid tumors; however, even with the development of better and less invasive surgical techniques, surgery is characterized by the increased risk of tumor metastasis, accelerated growth of pre-existing micrometastasis and cancer recurrence. Total intravenous anesthesia (TIVA) and regional anesthesia have been proposed to improve long-term outcomes after cancer surgery by different mechanisms, including attenuation of the neuroendocrine response, immunosuppression, decreased opioid requirements (opioids promote angiogenesis and tumor growth) and avoidance of volatile inhalational agents. ⋯ Several randomized controlled trials (RCTs) are in progress and may provide a better understanding regarding the role of the anesthesiologist in cancer surgery. The purpose of this review is to summarize the experimental and human data regarding the effect of anesthesia agents and anesthesia techniques on cancer outcomes.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewRisk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing?
Various risk stratification tools are used to predict patients' risk of adverse outcomes. Most of these tools are based on type of surgery and patient comorbidities. Accuracy of risk prediction is improved when additional factors such as functional capacity are included. ⋯ Technological advancement in data collection will likely improve existing risk assessment and allow development of new options. Future research should focus on establishing and standardizing perioperative outcomes that include meaningful patient-centric considerations such as quality of life. We review available stratification tools and important risk assessment biomarkers that address the most common causes of adverse outcomes.