Artificial intelligence (AI) applications are increasingly being used in areas of medicine such as radiology. However, within anesthesiology, there is not widespread use of AI applications at this time, though it has the potential to have a profound impact. Many applications of AI, including machine learning, deep learning, and natural language processing, are being used to create applications to enhance patient monitoring, optimize drug administration, improve decision-making, and predict postoperative complications.
Nonoperating room anesthesia has become an increasingly significant part of anesthetic practices, with endoscopy comprising a large portion of these cases. Unique considerations for anesthesia for endoscopy include specific gastrointestinal conditions which predispose patients to aspiration, as well as particular endoscopic procedures that may require endotracheal intubation. Finally, advances in anesthetic practice have emerged in endoscopy practices as well, creating novel ways to care for patients in unconventional settings. This article goes over management of patients for endoscopy and recent advances in this area that can further optimize patient care in this setting.
Pain is a common event after surgery and impacts a patient's satisfaction, quality of life, and recovery. Single-injection nerve blocks provide effective analgesia but are limited to 6 to 10 hours, often resulting in rebound pain. Strategies to prolong analgesia include continuous nerve catheters, perineural adjuncts (dexamethasone, dexmedetomidine, buprenorphine, clonidine, and epinephrine), and liposomal bupivacaine. Continuous nerve catheters remain the most effective but require technical expertise. Emerging options such as peripheral nerve stimulation show promise in reducing postoperative pain and opioid reliance. Further research is needed to optimize safety and efficacy.
Several situations in anesthesia practice exist where medications are mixed; for instance, local anesthetics-additive mixtures to increase block duration, propofol-lidocaine mixture to reduce pain on injection, the sequential injection of different substances into a peridural catheter, or the mix of different intravenous sedatives and analgesics before application. This article recommends a cautious, evidence-based approach to medication mixing in anesthesia practice, with careful consideration of available alternatives. Future research should focus on establishing compatibility standards, improving provider education, and identifying which mixtures offer benefits that outweigh the potential risks.
This article explores the role of acupuncture in modern medicine, particularly in perioperative care. It discusses acupuncture's origins, its increasing use for pain management, and its potential to reduce opioid consumption. Research, including neuroimaging studies, suggests that acupuncture influences brain activity, though its effectiveness under general anesthesia requires further investigation. The introduction of perioperative acupuncture highlights its benefits, including improved gastric emptying, reduced anesthetic needs, and enhanced postoperative recovery. Despite its advantages, regulatory barriers, provider awareness, and inadequate reimbursement limit adoption. Expanding acupuncture's use in perioperative settings could improve surgical outcomes and reduce opioid reliance.
The ability to remotely monitor patients after hospital discharge with near real-time feedback with an integrated health network represents a technological advancement that has shown promising results across surgical and medical domains including improvements in hospital length of stay, unplanned readmission, and mortality. COVID-19 and improvements in monitoring technology has catalyzed the increased use and evaluation of remote monitoring. In this article, we provide a landscape of remote monitoring and its role in postdischarge care to date across medical and surgical domains in adult medicine. We also address implementation, research, and ethical considerations for remote monitoring in clinical care.
Anesthesia providers can make significant impacts on the short-term and long-term health and well-being of lactating patients who present for anesthesia care. Development of a lactation-compatible anesthetic plan that supports the patient's individual breastfeeding goals and provides procedural conditions with symptom management is possible. Considerations for preoperative evaluation, intraoperative medications and management, and postoperative symptom management and care coordination are discussed.
The use of ultrasound in the perioperative setting is rapidly growing due to its increased availability and expanding applications. Given this rapid growth, understanding the basic perioperative uses is now essential for the anesthesiologist. This review covers the most common applications of perioperative ultrasound, including cardiac, thoracic, abdominal, airway, and vascular assessment, with a review of clinical applications and image acquisition as well as a brief overview of the application of point-of-care ultrasound for global health.
Total knee and hip replacements are commonly performed procedures, increasing in frequency. Perioperative complications, although rare, can impair patient recovery. Anesthetic choice has been speculated to impact complications. Based on this literature, it is evident that neuraxial anesthesia and specifically spinal anesthesia offers benefits when chosen as the anesthetic technique. These advantages include better postoperative pain control, reduced postoperative nausea and vomiting, and shortened hospital length of stay. Other outcomes such as incidence of deep vein thrombosis and pulmonary embolism, frequency of postoperative delirium, perioperative blood loss, and 30-day mortality appear not to be impacted by the choice of anesthetic technique.
Noncardiac implanted medical devices are utilized to treat an ever-increasing variety of patient ailments. Identification and proper management of these implants is necessary to avoid therapy disruption and patient harm. This review will explore the basic principles related to safe device management in the setting of planned surgery. We will discuss concerns related to electromagnetic interference, and its implications for the planned use of surgical instruments such as electrocautery. Devices will be broadly categorized by anatomic region likely to be encountered.
Inadequate management of acute pain resulting from surgery, trauma, or acute illness can result in potentially severe consequences for patients. Effective pain management is crucial for improving patient outcomes and strongly predicts quality of care. Acute Pain Management Service (APMS) within health care institutions ensures adequate pain relief. By establishing institutional policies and guidelines, an effective APMS can enhance patient outcomes safety. In private practice settings, the need for an APMS is even more critical. Fostering a multidisciplinary approach is key to the successful delivery of pain management in private health care settings, ensuring comprehensive and effective care for patients.
