Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewCentral venous catheter insertion: Review of recent evidence.
Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. ⋯ These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewOptimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review.
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. ⋯ Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewEpidural analgesia for postoperative pain: Improving outcomes or adding risks?
Current evidence shows that the benefits of epidural analgesia (EA) are not as impressive as believed in the past, while the risks of adverse effects and serious complications are greater than previously estimated. There are many reasons for the decreasing role of epidural technique in clinical practice (table). Indeed, EA can cause harm and hinder early mobilization in enhanced recovery after surgery (ERAS) programmes. ⋯ Increasingly, these non-EA methods are being used as surgeon-delivered regional analgesia (RA) techniques. This encouraging trend of active surgeon participation, with anaesthesiologist collaboration, will undoubtedly improve the decades-old twin problems of underused RA techniques and undertreated postoperative pain. The continued use of EA at any institution can only be justified by results from its own audits; however, regrettably only very few institutions perform such regular audits.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewSex and gender differences in anesthesia: Relevant also for perioperative safety?
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. ⋯ Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewSafety and quality of perioperative anesthesia care-Ensuring safe care for older people living with frailty.
The clinical concept of frailty as a detectable and improvable clinical condition has emerged in the field of geriatric medicine over the past two decades. Albeit frailty can be described as the rapid deterioration of organ function during the physiological aging process, this syndrome is not exclusively limited to the elderly. Recently, this concept has been introduced in the field of anesthesia and critical care as a means to better appraise perioperative risks and offer patient-centered individual treatment pathways. ⋯ Ongoing and future research is aimed at developing automated systems that help in harnessing standard medical records for reliable frailty screening without additional user input. Further efforts are pointed at understanding the potential reversibility of frailty through interventions such as exercise or nutritional supplements. While the role of frailty detection, quantification, and treatment in anesthesia and critical care is limited today, it is likely that it may become a key element of perioperative care of older patients in the near future.