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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 -
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 -
Anesthesiology Jul 2020The neural circuits underlying the distinct endpoints that define general anesthesia remain incompletely understood. It is becoming increasingly evident, however, that... (Review)
Review
The neural circuits underlying the distinct endpoints that define general anesthesia remain incompletely understood. It is becoming increasingly evident, however, that distinct pathways in the brain that mediate arousal and pain are involved in various endpoints of general anesthesia. To critically evaluate this growing body of literature, familiarity with modern tools and techniques used to study neural circuits is essential. This Readers' Toolbox article describes four such techniques: (1) electrical stimulation, (2) local pharmacology, (3) optogenetics, and (4) chemogenetics. Each technique is explained, including the advantages, disadvantages, and other issues that must be considered when interpreting experimental results. Examples are provided of studies that probe mechanisms of anesthesia using each technique. This information will aid researchers and clinicians alike in interpreting the literature and in evaluating the utility of these techniques in their own research programs.
Topics: Anesthesia, General; Anesthesiology; Anesthetics; Animals; Electric Stimulation; Humans; Neural Pathways; Optogenetics; Research
PubMed: 32349073
DOI: 10.1097/ALN.0000000000003279 -
Pain Physician May 2017Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently,... (Review)
Review
BACKGROUND
Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently, the literature is sparse on the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing locations outside of the operating room where implanted SCS can interact with surrounding medical equipment and pose significant risk to patient and device.
OBJECTIVES
The objective of this review is to present relevant known literature about the safe management of SCS in the perioperative period and to begin to develop recommendations.
STUDY DESIGN
A review of current literature and each manufacturers' labeling was performed to assess risk of interference and patient harm between SCS and technology used in and around typical anesthetizing locations.
METHODS
A systematic search of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A computerized search was conducted for English articles in print up to April 2016 via PubMed www.ncbi.nlm.nih.gov/pubmed; EMBASE www.embase.com; and Cochrane Library www.thecochranelibrary.com. Search terms included "spinal cord stimulator AND MRI," "spinal cord stimulator AND ECG," "spinal cord stimulator AND implanted cardiac device," "spinal cord stimulator AND electrocautery," and "spinal cord stimulator AND obstetrics." In addition, a search of Google and Google Scholar was performed. Websites of SCS manufactures were reviewed.
RESULTS
Generalized recommendations include turning the amplitude of the SCS to the lowest possible SETTING and turning off prior to any procedure. Monopolar electrocautery is contraindicated but is still often utilized; placing grounding pads as far away from the device can reduce the risk to device and patient. Bipolar cautery is favored. Implanted cardiac devices can interfere with SCS, but risks can be minimized. Neuraxial anesthesia can be attempted in a patient with implanted SCS, provided the device is not in the expected path. MRI labeling differences present the biggest difference among SCS manufactures. Medtronic's SureScan SCS, Boston Scientific's Precision system, St. Jude's Proclaim, and Stimwave's Freedome SCS are full body MRI compatible under specific conditions, while other manufacturers have labeling that restricts exams of the trunk and certain extremities.
LIMITATIONS
This review was intended to be a comprehensive, cumulative review of recommendations for perioperative SCS management; however, the limitations of a review of this nature is the complete reliance on previously published research and the availability of these studies using the methods outlined.
CONCLUSIONS
SCS is being used earlier in the treatment algorithm for patients with chronic pain. The anesthesia care team needs working knowledge of where the device resides in the neuraxial space and what risks different medical technologies pose to the patient and device. This understanding will lead to appropriate perioperative management which can reduce risk and improve patient outcomes.
Topics: Anesthesiology; Anesthetics; Chronic Pain; Humans; Pain Management; Perioperative Care; Spinal Cord; Spinal Cord Stimulation
PubMed: 28535554
DOI: No ID Found -
Anesthesia and Analgesia Jan 2022Epidermolysis bullosa (EB) is a group of rare, inherited diseases characterized by skin fragility and multiorgan system involvement that presents many anesthetic... (Review)
Review
Epidermolysis bullosa (EB) is a group of rare, inherited diseases characterized by skin fragility and multiorgan system involvement that presents many anesthetic challenges. Although the literature regarding anesthetic management focuses primarily on the pediatric population, as life expectancy improves, adult patients with EB are more frequently undergoing anesthesia in nonpediatric hospital settings. Safe anesthetic management of adult patients with EB requires familiarity with the complex and heterogeneous nature of this disease, especially with regard to complications that may worsen during adulthood. General, neuraxial, and regional anesthetics have all been used safely in patients with EB. A thorough preoperative evaluation is essential. Preoperative testing should be guided by EB subtype, clinical manifestations, and extracutaneous complications. Advanced planning and multidisciplinary coordination are necessary with regard to timing and operative plan. Meticulous preparation of the operating room and education of all perioperative staff members is critical. Intraoperatively, utmost care must be taken to avoid all adhesives, shear forces, and friction to the skin and mucosa. Special precautions must be taken with patient positioning, and standard anesthesia monitors must be modified. Airway management is often difficult, and progressive airway deterioration can occur in adults with EB over time. A smooth induction, emergence, and postoperative course are necessary to minimize blister formation from excess patient movement. With careful planning, preparation, and precautions, adult patients with EB can safely undergo anesthesia.
Topics: Airway Management; Anesthesia; Anesthesiology; Anesthetics; Epidermolysis Bullosa; Humans; Operating Rooms; Patient Safety; Perioperative Care; Perioperative Period; Postoperative Care; Preoperative Care; Respiratory System; Skin
PubMed: 34403382
DOI: 10.1213/ANE.0000000000005706 -
British Journal of Anaesthesia Sep 2019
Topics: Anesthesiology; Anesthetics; Drug Overdose; Humans
PubMed: 30915995
DOI: 10.1016/j.bja.2018.12.012 -
Medicine Jul 2023The level of endothelial glycocalyx (EG) shedding is associated with morbidity and mortality, and vascular endothelial barrier dysfunction is one of the pivotal clinical... (Review)
Review
The level of endothelial glycocalyx (EG) shedding is associated with morbidity and mortality, and vascular endothelial barrier dysfunction is one of the pivotal clinical problems faced by critically ill patients, so research on the protective effects of EG is of great clinical significance for the treatment of critically ill diseases. Studies have illustrated that clinical anesthesia has different degrees of effects on vascular EG. Therefore, we reviewed the effects of distinct anesthesia methods and diverse anesthetic drugs on EG, aiming to provide a brief summary of what we know now, and to discuss possible future directions for investigations in this area. So as to provide a theoretical basis for future research on potential EG-positive drugs and targets, to minimize perioperative complications and improve the prognosis of surgical patients.
Topics: Humans; Glycocalyx; Critical Illness; Anesthesia; Anesthesiology; Endothelium, Vascular; Vascular Diseases; Anesthetics
PubMed: 37443493
DOI: 10.1097/MD.0000000000034265 -
British Journal of Anaesthesia Dec 2017The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the... (Review)
Review
The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the affected country is least able to respond. For this reason an international disaster response is often required. For many years this disaster response was not coordinated. The response consisted of what was available not what was needed and standards of care varied widely producing a healthcare lottery for the affected population. In recent years the World Health organisation has initiated the Emergency Medical Team programme to coordinate the response to disasters and set minimum standards for responding teams. Anaesthetists have a key role to play in Level 2 Surgical Field Hospitals. The disaster context produces a number of logistical challenges that directly impact on the anaesthetist requiring adaptation of anaesthetic techniques from their everyday practice. The context in which they will be working and the wider scope of practice that will be expected from them in the field mandates that deploying anaesthetists should be trained for disaster response. There have been significant improvements in recent years in the speed of response, equipment availability, coordination and training for disasters. Future challenges include increasing local disaster response capacity, agreeing international standards for training and improving data collection to allow for future research and improvement in disaster response. The goal of this review article is to provide an understanding of the disaster context and what logistical challenges it provides. There has been a move during the last decade from a globally uncoordinated, unregulated response, with no consensus on standards, to a globally coordinated response through the World Health Organisation (WHO). A classification system for responding Emergency Medical Teams (EMTs) and a set of agreed minimum standards has been defined. This review outlines the scope of the role of the anaesthetist in a Level 2 field hospital and some of the challenges that this scope and context present. It focuses mainly on natural disasters, but also outline some of the differences encountered in responding to other global disasters such as conflict and infectious outbreaks, and concludes with some of the challenges for the future.
Topics: Anesthesiology; Anesthetics; Disasters; Emergencies; Global Health; Humans; Internationality
PubMed: 29161394
DOI: 10.1093/bja/aex353 -
Anesthesiology Mar 2018
Topics: Anesthesia, Dental; Anesthesiology; Anesthetics; Cohort Studies; Hip Fractures; Humans
PubMed: 29324481
DOI: 10.1097/ALN.0000000000002074