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Korean Journal of Anesthesiology Feb 2020The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these... (Review)
Review
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
Topics: Age Factors; Aged; Anesthesiologists; Anesthesiology; Anesthetics; Humans; Perioperative Care; Postoperative Complications
PubMed: 31636241
DOI: 10.4097/kja.19391 -
British Journal of Anaesthesia Nov 2020The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere,... (Review)
Review
The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.
Topics: Anesthesia; Anesthesiology; Anesthetics; Carbon; Climate Change; Conservation of Natural Resources; Critical Care; Environmental Pollutants; Environmental Pollution; Equipment Reuse; Humans; Recycling; Shock, Septic
PubMed: 32798068
DOI: 10.1016/j.bja.2020.06.055 -
Current Opinion in Anaesthesiology Feb 2020With the growing of the aging population, increased and new methods of anesthesia and surgery allow for surgery and other interventions in older adults.Pharmacokinetics... (Review)
Review
PURPOSE OF REVIEW
With the growing of the aging population, increased and new methods of anesthesia and surgery allow for surgery and other interventions in older adults.Pharmacokinetics and pharmacodynamics of drugs in older adults differ from those in younger and middle-aged adults. However, the geriatric population is frequently neglected in the context of clinical trials. The present review focuses on the consequences of multimorbidity and pharmacokinetic and pharmacodynamic alterations and their implications on anesthesia.
RECENT FINDINGS
Physiologically based pharmacokinetic and pharmacodynamic modeling may serve as an option to better understand the influence of age on drugs used for anesthesia. However, difficulties to adequately characterize geriatric patients are described.
SUMMARY
Further research of drug effects in the aging population may include physiologically based pharmacokinetic and pharmacodynamic complex models and randomized controlled trials with thoroughly conducted geriatric assessments.
Topics: Aged; Anesthesia; Anesthesiology; Anesthetics; Geriatric Assessment; Humans; Middle Aged
PubMed: 31789903
DOI: 10.1097/ACO.0000000000000814 -
Journal of Neurosurgical Anesthesiology Apr 2021This review summarizes the literature published in 2020 that is relevant to the perioperative care of neurosurgical patients and patients with neurological diseases as... (Review)
Review
This review summarizes the literature published in 2020 that is relevant to the perioperative care of neurosurgical patients and patients with neurological diseases as well as critically ill patients with neurological diseases. Broad topics include general perioperative neuroscientific considerations, stroke, traumatic brain injury, monitoring, anesthetic neurotoxicity, and perioperative disorders of cognitive function.
Topics: Anesthesiology; Anesthetics; Humans; Neurosurgery; Neurosurgical Procedures; Perioperative Care
PubMed: 33480638
DOI: 10.1097/ANA.0000000000000757 -
European Journal of Anaesthesiology Oct 2022Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being... (Review)
Review
Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being restricted but volatile anaesthetics have been exempted from legislation, until now: the EU has formulated a proposal to ban or at least severely restrict the use of desflurane starting January 2026. This narrative review addresses the implications of a politics-driven decision - without prior consultation with major stakeholders, such as the European Society of Anaesthesiology and Intensive Care (ESAIC) - on daily anaesthesia practice and reviews the potential scientific arguments that would support stopping the routine use of desflurane in anaesthetic practice. Of note, banning or severely restricting the use of one anaesthetic agent should not distract the user from sensible interventions like reducing fresh gas flows and developing technology to capture and recycle or destroy the wasted potent inhaled anaesthetics that we will continue to use. We call to join efforts to minimise our professional environmental footprint.
Topics: Anesthesia; Anesthesiology; Anesthetics, Inhalation; Desflurane; Humans; Isoflurane
PubMed: 36036420
DOI: 10.1097/EJA.0000000000001739 -
British Journal of Anaesthesia Apr 2019Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major... (Review)
Review
Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain. Caudal blocks are an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. Performed on sedated children, they enable not only early ambulation, but also periprocedural haemodynamic stability and spontaneous breathing in patient groups at maximum risk of a difficult airway. These are important advantages over general anaesthesia, notably in preterm babies and in children with cardiopulmonary co-morbidities. Compared with other techniques of regional anaesthesia, a case for caudal blocks can still be made.
Topics: Anesthesia, Caudal; Anesthesiology; Anesthetics, Local; Auscultation; Child; Contraindications, Procedure; Education, Medical, Graduate; Epidural Space; Humans; Pain, Postoperative; Palpation; Ultrasonography, Interventional
PubMed: 30857607
DOI: 10.1016/j.bja.2018.11.030 -
Anesthesiology Clinics Dec 2022Acute aortic dissection is a highly morbid condition with high mortality that requires emergent surgical evaluation and repair. The intraoperative management of acute... (Review)
Review
Acute aortic dissection is a highly morbid condition with high mortality that requires emergent surgical evaluation and repair. The intraoperative management of acute aortic dissection requires the anesthesiologist to do far more than administer anesthesia and begins before the patient arrives at the operative theater. High-fidelity communication with the surgeon, knowledge of the surgical plan, knowledge of the anatomy of the dissection, and a nuanced understanding of aortic dissection pathophysiology are all critical aspects of anesthetic management.
Topics: Humans; Aortic Dissection; Anesthesiology; Anesthesia; Anesthetics
PubMed: 36328623
DOI: 10.1016/j.anclin.2022.08.012 -
Anasthesiologie, Intensivmedizin,... Oct 2022The climate crisis is omnipresent and one of the most pressing challenges of the 21st century. In the position paper "Ecological sustainability in anaesthesiology and...
The climate crisis is omnipresent and one of the most pressing challenges of the 21st century. In the position paper "Ecological sustainability in anaesthesiology and intensive care medicine", the Professional Association of German Anesthesiologists (BDA) and the German Society for Anesthesiology and Intensive Care Medicine (DGAI) made specific recommendations which contribute to a consistent and sustainable reduction in CO emissions. This article highlights the aspects of the position paper which the authors believe can be easily implemented in clinical practice and have a major effect on reducing CO emissions. The recommendations focus on the topics of medication, medical products, waste management, mobility, energy management, research and teaching with practical examples and results from the Green Team (Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn) and from the toolkit of the DGAI/BDA. Ways are shown to limit inhalation anesthetic-caused CO-emissions, to reduce drug waste, to change single-use for reusable materials and to develop sustainable waste concepts.
Topics: Anesthesiology; Anesthetics, Inhalation; Carbon Dioxide; Critical Care; Humans
PubMed: 36228602
DOI: 10.1055/a-1683-2164 -
Die Anaesthesiologie May 2023The reduction of greenhouse gases such as CO emissions and their equivalents (CO2e) generally has three aspects: Fugitive direct emissions (anesthetic gases, exhaust... (Review)
Review
The reduction of greenhouse gases such as CO emissions and their equivalents (CO2e) generally has three aspects: Fugitive direct emissions (anesthetic gases, exhaust gases), indirect emissions through the purchase of energy (electricity, heat) and emissions in the supply chain (supply of consumables, disposal). Since pediatric anesthesia has a traditional affinity with inhalation, the use of anesthetic gases should be repeatedly questioned and, if possible, avoided on the way to net zero emissions in addition to general measures to conserve resources. In children, analgosedation, total intravenous anesthesia (TIVA) and establishment of venous access prior to the induction of anesthesia are particularly suitable for this purpose. In addition to avoiding greenhouse gases, the methods mentioned offer other significant medical advantages and can also be profitable in terms of safety and comfort. Nevertheless, anesthetic gases are required in pediatric anesthesia in some situations. For this reason, it is important to save anesthetic gases through minimal fresh gas flow and a rational approach to inhalation induction. To facilitate implementation in clinical practice, this article provides recommendations for mask induction and choice of anesthetic procedure.
Topics: Humans; Child; Anesthetics, Inhalation; Greenhouse Gases; Anesthesia, General; Anesthesiology
PubMed: 36988636
DOI: 10.1007/s00101-023-01270-8 -
Journal of Neurosurgical Anesthesiology Apr 2018We provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill... (Review)
Review
We provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill patients with neurological diseases. We cover the following broad topics: general neurosurgery, spine surgery, stroke, traumatic brain injury, monitoring, and anesthetic neurotoxicity.
Topics: Adult; Anesthesia; Anesthesiology; Anesthetics; Child; Humans; Nervous System Diseases; Neurosurgical Procedures
PubMed: 29521890
DOI: 10.1097/ANA.0000000000000489