Current Anesthesiology Reports最新文献

Purpose of review: Older adults age >65 years are the fastest growing segment of the United States population, and many undergo non-cardiac surgery each year. Despite the high prevalence of cardiovascular disease in this population, data to guide perioperative care in older adults are limited. This review summarizes the literature on cardiovascular outcomes associated with noncardiac surgery in older adults, identifies unique clinical factors to consider in geriatric cohorts, and highlights clinical practice guidelines relevant to perioperative management of older adults.

Recent findings: Cardiovascular complications of noncardiac surgery are most common in older adults. Current cardiovascular risk calculators may significantly underestimate preoperative cardiovascular risk in these patients. Frailty assessments and novel risk calculators can improve risk stratification in older adults. Clinical factors, including coronary artery disease, heart failure, vascular stiffness, and aortic stenosis are key pathologies that may impact surgical outcomes. Pre-operative diagnostic cardiovascular testing may be helpful to identify cardiovascular disease in select patients, but routine testing is not generally recommended.

Summary: Older adults have worse perioperative cardiovascular outcomes than younger individuals. Providers should consider clinical factors beyond those captured in traditional risk perioperative calculators to guide clinical decision making prior to noncardiac surgery.

Purpose of review: High-quality evidence substantiates the use of regional anesthesia for elective total joint arthroplasty. The use of regional anesthesia in this surgical population, therefore, can also be used to evaluate health care disparities and measure health equity. This narrative review assesses and summarizes available literature on disparities in the use of regional anesthesia for total joint arthroplasty and identifies factors contributing to those disparities.

Recent findings: We found that disparities exist in the use of regional anesthesia for total joint arthroplasty and are multifactorial in origin, encompassing patient characteristics such as race and ethnicity and systemic factors such as hospital type and insurance status. However, there is an overall paucity of literature focused specifically on drivers of disparities, and no evidence supporting interventions that may alleviate known disparities.

Summary: Disparities in use of regional anesthesia for total joint arthroplasty are multifactorial in origin and encompass differences in care at the levels of race, ethnicity, hospital, and insurance status, among others. Additional work is needed at the epidemiologic level to understand what factors underlie known disparities in anesthesia care and how best to promote health equity for surgical patients undergoing this set of procedures.

Purpose of review: An increasing number of trauma patients are elderly. These patients present unique challenges due to their distinct physiological changes and injury patterns. This article aims to summarize recent literature on perioperative management of geriatric trauma patients for anesthesia providers.

Recent findings: Ageing is a multisystem process which may impair the ability of the older person to physiologically respond to trauma. The addition of frailty may further increase their vulnerability to complications.With regards to operative planning, regional anesthesia has not been shown to reduce the risk of delirium compared to general anesthesia. This has been mostly shown with regards to hip fractures, an injury with a high incidence amongst the elderly. There was no reduction in mortality with accelerated hip fracture repair within 6 h of presentation.

Summary: Geriatric patients sustain different injuries and mount more limited physiological responses to trauma than their younger counterparts. Pre-existing frailty amongst the elderly may also contribute to complications in the perioperative period.

Purpose of review: We examine what is known, what is new, and what is emerging in acute neurotrauma relevant to the anesthesiologist.

Recent findings: Timely and goal-directed care is critical for all patients requiring urgent/emergent anesthesia care. Anesthesia care for acute neurological injury should incorporate understanding the evolution of traumatic brain injury and spinal cord injury that translates to preoperative preparation, hemodynamic resuscitation, prevention of second insults, and safe transport between care settings. Anesthesia care should support optimizing patient outcomes.

Summary: Best practices involve extrapolating data from the intensive care unit setting since there is a lack of research addressing anesthesia care for acute neurological injury. There are opportunities to generate data to support evidence-based anesthetic care.