Articles: general-anesthesia.
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The issue of potentially harmful effects of neurotoxicity or anaesthesia management on children undergoing general anaesthesia is still not resolved. Studies have so far been limited by methodological problems. In a retrospective cohort study, a new noninvasive method was used to demonstrate visual processing changes in children with a single previous exposure to anaesthesia. We need new noninvasive methods that can be used before and after exposure to anaesthesia and surgery to detemine possible effects on long-term neurodevelopment.
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Editorial Letter Comparative Study
Enhancing anaesthetic care for the elderly: Propofol versus remimazolam for general anaesthesia.
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Editorial Comparative Study
General versus spinal anesthesia: are we asking the right question?
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How continuous cerebral autoregulation (CCA) knowledge should be optimally gained and interpreted is still an active area of research and refinement. We now experience a unique situation of having indices clinically available before definitive evidence of benefit or practice guidelines, in a moment when high rates of institutional variability exist both in the application of monitoring as well as in monitoring-guided treatments. Responses from 47 international clinicians, experts in this field, were collected with polling and discussion of the results. ⋯ There was nearly universal interest to participate in an RCT, with agreement that the research community must together determine end points and interventions to reduce wasted effort and time, and that investigations should include the following: the most appropriate way of inclusion of CCA into the clinical workflow; whether CCA-guided interventions should be prophylactic, proactive; or reactive; and whether a CCA-centric (unimodal) or a multimodal monitoring-integrated tiered therapy approach should be adopted. Pediatric and neonatal populations were highlighted as having urgent need and even more plausibility than adults. On the whole, the initiative was enthusiastically embraced by the experts, with the general feeling that a strong push should be now made by the community to convert the plausible benefits of CCA monitoring, already implemented in some centers, into a more standardized and RCT-validated clinical reality.