Anesthesia and critical care (Houston, Tex.)最新文献

Ketamine has unique properties making it a desirable drug to induce general anesthesia during surgery. However, it is typically reserved for children and adolescent patients due to its side effects in adults, including vivid dreams, hallucinations, and confusional states that may be pleasant or distressing. These symptoms may affect patients with post-traumatic stress disorder (PTSD). PTSD is a trauma-related psychological disorder that is mainly characterized by intrusive thoughts, hypervigilance, and re-experiencing of the trauma event. Most of current research focuses on the use of sub-anesthetic doses of ketamine as a treatment for PTSD. Limited information is known about high-dose ketamine use during general anesthesia and the impact this has on patients who suffer from PTSD. A literature review investigating the effects of anesthetic doses of ketamine on PTSD was conducted for this article. Findings suggest that ketamine has dose-related effects on the severity of PTSD. Specifically, low-dose ketamine has the potential as a therapeutic agent in the treatment of PTSD, while high-dose ketamine may cause worsening of PTSD symptoms. This could occur through the increase in psychomimetic symptoms, decrease in plasticity and metaplasticity, and modulation of fear memory systems experienced with anesthetic doses of ketamine. Currently, there are no published research articles directly measuring the effects of high-dose ketamine on PTSD. Further investigation is warranted to understand if anesthetic doses of ketamine worsen PTSD symptoms. This is important because it can help guide the management approach of an anesthesiologist to safely providing anesthesia to PTSD patients.

The successful management of postoperative pain remains a significant challenge to patient recovery following high-risk surgeries, often leading to the overuse of opioids and increasing dangers for developing chronic post-surgical pain (CPSP). CPSP is defined as pain persisting for at least 3 months after surgery, beyond the expected healing window. CPSP can develop after any type of surgery, but especially very traumatic ones- where nerve injury, inflammation, and abnormal central sensitization cause acute postoperative pain to transition into chronic pain. Multimodal analgesia (MMA) is an integrated pain management approach that employs a wide range of drug interventions with the end goal of achieving a synergistic effect in pain reduction and recovery. This method is used to reduce the necessity for opioids due to their addictive properties and other detrimental side effects. Anchored in Enhanced Recovery After Surgery (ERAS) protocols, MMA is a tailored approach that takes into consideration various pain pathways, such as nociceptive, neuropathic, and inflammatory. These methods can widely differ across various surgical categories, as each patient and procedure present distinct complications to address. Current studies offer a vast array of interventions with shifting impacts on recovery, though there is general agreement on certain specific, consistently effective approaches. This review critically reviewed the most widely accepted MMA strategies across orthopedic, thoracic, abdominal, breast, and amputation procedures, while also identifying areas for further optimization. Overall, the multimodal analgesia reduces opioid intake in the postoperative setting and benefits patients undergoing multiple procedures. However, there is a need for integrative, patient-tailored algorithms supported by predictive analytics and perioperative data to personalize MMA plans. Further investigations using high-quality, procedure-specific randomized controlled trials are warranted to evaluate short-term analgesic success and long-term quality-of-life metrics.

Artificial intelligence (AI) is transforming anesthesiology, showcasing applications that address patient monitoring, closed-loop anesthetic delivery, risk forecasting, customized management, and workflow betterment. This review highlights modern developments, analyzing the role of AI from early rule-based systems to machine learning and deep learning models, aided by the foundational role of anesthesia information Management Systems. AI processes depict strong performance of the clinical team and allowing anesthesiologists to intervene earlier in cases of intraoperative hypotension, acute kidney injury, tissue hypoxia, and giving them more time to focus on complex patient cases. Closed-loop systems guided by the physiologic and electroencephalogram feedback exemplify the ability of AI to maintain anesthetic stability while reducing clinician workload. Predictive models help with the American Society of Anesthesiologists' classification in categorizing the patients, airway risk stratification, and customized treatment planning with improving preoperative evaluation. A move toward precision anesthetic administration is indicated by new developments in pharmacogenomics, perioperative pain characterization, and AI-assisted ultrasonography. Beyond clinical gains, AI guarantees improved operating room efficiency through organized scheduling, natural language processing documentation. Yet, widespread integration of AI in anesthesia still faces barriers regarding ethical concerns, clinical doubt, including replicability amongst healthcare systems, and a lack of in-depth data regarding the topic. Addressing these concerns demands data from multicenters, interdisciplinary education, and integration of explainable AI frameworks that are palatable to the clinical world. Overall, AI has the potential to behave as an adjunct, instead of replacing anesthesiologists by aiding in decision making, improving patient safety, and preparing for perioperative care.

Healthcare disparities continue to affect communities in the United States that are racially and ethnically diverse, disabled, and economically disadvantaged, even though medical and technological advancements have made great strides in these areas. Disparities in health outcomes and difficulties obtaining care for both acute and chronic illnesses are more common among these populations when compared to the overall population. Disparities in anesthesia care delivery have been documented in multiple studies, and they are based on factors such as patients' racial/ethnic background, gender, sexual orientation, ability to communicate in English, and accessibility to health insurance. Despite this, there are limited reports in academic journals on the differences in general anesthesia. This article provides a critical review of literature on racial and ethnic disparities in the use of general anesthesia for adults having obstetric, general, or pediatric surgeries, as well as for their preoperative, intraoperative, and postoperative anesthesia care.

Anesthesiologists and the critical care team may be at increased risk of contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, COVID-19) due to airway manipulations and intubations performed during anesthesia administration and management of patient undergoing surgery. SARS-CoV-2 infections have been reported among healthcare workers. The virus is transmitted by close personal contact and aerosols. During intubation and other procedures involving the airway, the anesthesiologist is especially susceptible to aerosols. We performed a systematic analysis of the published reports on potential effects of COVID-19 during surgery on the anesthesiologist and critical care team. and identified potential immunomodulatory effects of general anesthetics in the presence of COVID-19 infection in patients. The article also provides critical discussion on the current medical management of COVID-19 and highlights the evidence-based key points for a safer practice during anesthesia administration and surgeries both in children and adults, including obstetric procedures and how it could affect pregnant women receiving anesthesia. With regional anesthesia, airway manipulation is not necessary, and healthcare workers and other patients are less likely to contract the same infection.