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Anaesthesia Jan 2021
Topics: Anesthesia, Conduction; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Nerve Block
PubMed: 33426654
DOI: 10.1111/anae.15321 -
Anaesthesia Jan 2022Stroke is a leading cause of death and disability, and is associated with a huge societal and economic burden. Interventions for the immediate treatment of ischaemic... (Review)
Review
Stroke is a leading cause of death and disability, and is associated with a huge societal and economic burden. Interventions for the immediate treatment of ischaemic stroke due to large vessel occlusion are dependent on recanalisation of the occluded vessel. Trials have provided evidence supporting the efficacy of mechanical thrombectomy in ischaemic stroke due to large vessel occlusion. This has resulted in changes in management and organisation of stroke care worldwide. Major determinants of effectiveness of thrombectomy include: time between stroke onset and reperfusion; location of occlusion and local collateral perfusion; adequacy of reperfusion; patient age; and stroke severity. The role of anaesthetic technique on outcome remains controversial with published research showing conflicting results. As a result, choice of conscious sedation or general anaesthesia for mechanical thrombectomy is often dependent on individual operator choice or institutional preference. More recent randomised controlled trials have suggested that protocol-driven general anaesthesia is no worse than conscious sedation and may even be associated with better outcomes. These and other studies have highlighted the importance of optimal blood pressure management as a major determinant of patient outcome. Anaesthetic management should be tailored to the individual patient and circumstances. Acute ischaemic stroke is a neurological emergency; clinicians should focus on minimising door-to-groin puncture time and the provision of high-quality periprocedural care with a particular emphasis on the maintenance of an adequate blood pressure.
Topics: Anesthesia, General; Anesthesia, Local; Brain Ischemia; Conscious Sedation; Humans; Intraoperative Complications; Randomized Controlled Trials as Topic; Stroke; Thrombectomy
PubMed: 35001387
DOI: 10.1111/anae.15586 -
British Journal of Anaesthesia Jun 2023A randomised trial published in the British Journal of Anaesthesia describes hypnosis compared with general anaesthesia in 60 children undergoing superficial surgery. We...
A randomised trial published in the British Journal of Anaesthesia describes hypnosis compared with general anaesthesia in 60 children undergoing superficial surgery. We describe a definition of clinical hypnosis; the goals and conduct of hypnotic communication; and its potential as both an adjunct and, in suitable cases, alternative to traditional pharmacological anaesthesia.
Topics: Child; Humans; Hypnosis; Anesthesia, General; Perioperative Care
PubMed: 36967280
DOI: 10.1016/j.bja.2023.02.024 -
Medicine Oct 2023Pediatric anesthesia is one of the most concerning topics in our society. However, there is still a lack of a comprehensive overview of the research base and of future... (Review)
Review
Pediatric anesthesia is one of the most concerning topics in our society. However, there is still a lack of a comprehensive overview of the research base and of future trends. This study aimed to guide beginners quickly learn the academic research on pediatric anesthesia and do their own studies by analyzing the articles of this field in the latest 21 years through bibliometric analysis. Literature scanning was conducted with the Web of Science database. Microsoft Excel, SPSS, VOSviewer, and CiteSpace were in this review. There was an increasing trend of articles on pediatric anesthesia, based on the analysis of 11,591 included articles. The top 3 most productive countries were the United States of America (4538), Canada (730) and Turkey (688). The most productive institutions were Boston Childrens hospital, Childrens Hospital Philadelphia and Ohio State University. Tobias, Joseph D (141), Kim, Hee-Soo (40) and Curley, Martha A Q (38) were the most active authors. Habre W (2017), Gross JB (2002) and Cravero JP (2009) are the articles cited more than 100 times during the analysis years. Anesthesia and Analgesia, Anesthesiology, Pediatric Anesthesia, were the core journals in this field. Cohort, simulation, sleep, postoperative complication are strongest burst keywords in recent years. This article summarizes the authoritative institutions, authors, literatures and frontier hotspots on pediatric anesthesia. Itwill be a valuable literature review and help beginners to quickly get started in the field, reduce unnecessary clueless and aimless learning, and greatly improve learning efficiency.
Topics: Child; Humans; Analgesia; Anesthesia; Anesthesiology; Bibliometrics
PubMed: 37904397
DOI: 10.1097/MD.0000000000035626 -
Anaesthesia Apr 2023Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in... (Review)
Review
Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.
Topics: Humans; Anesthesia; Anesthesiology
PubMed: 36630729
DOI: 10.1111/anae.15920 -
Medicina (Kaunas, Lithuania) Apr 2024Training and expertise in regional anaesthesia have increased significantly in tandem with increased interest over the past two decades. This review outlines the most... (Review)
Review
Training and expertise in regional anaesthesia have increased significantly in tandem with increased interest over the past two decades. This review outlines the most recent advances in regional anaesthesia and focuses on novel areas of interest including fascial plane blocks. Pharmacological advances in the form of the prolongation of drug duration with liposomal bupivacaine are considered. Neuromodulation in the context of regional anaesthesia is outlined as a potential future direction. The growing use of regional anaesthesia outside of the theatre environment and current thinking on managing the rebound plane after regional block regression are also discussed. Recent relevant evidence is summarised, unanswered questions are outlined, and priorities for ongoing investigation are suggested.
Topics: Humans; Anesthesia, Conduction; Anesthetics, Local; Nerve Block; Bupivacaine
PubMed: 38792918
DOI: 10.3390/medicina60050735 -
Anesthesiology Dec 2021
Topics: Anesthesia, Inhalation; Anesthetics, Inhalation; Hemodynamics; Lung; Respiration, Artificial
PubMed: 34731246
DOI: 10.1097/ALN.0000000000004038 -
Anaesthesia Feb 2022In 2019, the scientists who discovered how cells sense and adapt to oxygen availability were awarded the Nobel Prize. This elegant sensing pathway is conserved... (Review)
Review
In 2019, the scientists who discovered how cells sense and adapt to oxygen availability were awarded the Nobel Prize. This elegant sensing pathway is conserved throughout evolution, and it underpins the physiology and pathology that we, as clinicians in anaesthesia and critical care, encounter on a daily basis. The purpose of this review is to bring hypoxia-inducible factor, and the oxygen-sensing pathway as a whole, to the wider clinical community. We describe how this unifying mechanism was discovered, and how it orchestrates diverse changes such as erythropoiesis, ventilatory acclimatisation, pulmonary vascular remodelling and altered metabolism. We explore the lessons learnt from genetic disorders of oxygen sensing, and the wider implications in evolution of all animal species, including our own. Finally, we explain how this pathway is relevant to our clinical practice, and how it is being manipulated in new treatments for conditions such as cancer, anaemia and pulmonary hypertension.
Topics: Anesthesia; Animals; Critical Care; Humans; Hypoxia; Hypoxia-Inducible Factor 1, alpha Subunit; Oxygen; Oxygen Consumption
PubMed: 34555179
DOI: 10.1111/anae.15582 -
Cardiovascular Journal of Africa 2022
Topics: Anesthesia, Conduction; Humans
PubMed: 35904555
DOI: 10.5830/CVJA-2022-034 -
British Journal of Anaesthesia Jan 2023Over the 90 years since the first description of one-lung ventilation, the practice of thoracic surgery and anaesthesia continues to develop. Minimally invasive surgical...
Over the 90 years since the first description of one-lung ventilation, the practice of thoracic surgery and anaesthesia continues to develop. Minimally invasive surgical techniques are increasingly being used to minimise the surgical insult and facilitate improved outcomes. Challenging these outcomes, however, are parallel changes in patient characteristics with more older and sicker patients undergoing surgery. Thoracic anaesthesia as a speciality continues to respond to these challenges with evolution of practice and strong academic performance.
Topics: Humans; Anesthesia; Thoracic Surgical Procedures; Anesthesiology; One-Lung Ventilation; Anesthetics
PubMed: 36470744
DOI: 10.1016/j.bja.2022.10.034