Multidisciplinary Postoperative Ileus Management: A Narrative Review.

Postoperative ileus is a prolonged impairment of gastrointestinal motility following surgical procedures. This often leads to increased morbidity, extended hospital stays, and high healthcare expenditures. In this review, we discuss the pathophysiology underlying postoperative ileus, its epidemiology, and perioperative management strategies.

Molecular Mechanisms and Potential Therapeutic Targets of Ischemia-Reperfusion Injury in Kidney Transplantation.

End-stage renal disease (ESRD) is a serious and lethal disease that carries with it a high morbidity and mortality rate if left untreated. Treating ESRD is conducted via renal replacement therapy and/or kidney transplantation, with the latter being the preferred option given the better outcomes and quality of life for the patients. However, as ESRD rises in prevalence, kidney transplantation rates remain largely unchanged.

The Perioperative Biochemical and Clinical Considerations of Pheochromocytoma Management.

Pheochromocytoma, a rare catecholamine-secreting tumor, poses significant perioperative challenges due to its potential for severe hemodynamic instability. Careful management of patients with pheochromocytoma is critical for patient safety and favorable outcomes. The diagnostic workup focuses on biochemical analysis of plasma or urinary metanephrines, followed by imaging for tumor localization and genetic testing to identify hereditary syndromes.

The utility of generative artificial intelligence Chatbot (ChatGPT) in generating teaching and learning material for anesthesiology residents.

The popularization of large language chatbots such as ChatGPT has led to growing utility in various biomedical fields. It has been shown that chatbots can provide reasonably accurate responses to medical exam style questions. On the other hand, chatbots have known limitations which may hinder their utility in medical education.

Bringing Clarity to Complex Pediatric Perioperative Care: Development of a Novel Pathway to Support Goal-Directed, Patient-Centered Care.

Background: Advances in pediatric perioperative care have supported the safe provision of increasingly complex surgical care to patients with complicated diseases and abnormal physiology. This has led to the possible misalignment of the impact of potential surgical outcomes and goals of care. Methods / Objectives: We describe the development of a novel process that leverages the combination of longitudinal engagement of pediatric palliative care consultants and multidisciplinary care planning to ensure that perioperative care remains patient-centered and goal-directed for all children, especially children with complex baseline disease.

Blood Pressure Variability After Acute Ischemic Stroke and Intracerebral Hemorrhage: Refining Its Definition, Intervention Opportunities, and Research Directions.

Increased blood pressure variability (BPV) in the acute phases of cerebrovascular emergencies, such as acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), has been shown to result in worsened outcomes. Although several studies have reported this association, no consensus exists for specific BPV targets or a consistent, unified definition of BPV in AIS or ICH. Therefore, we convened the Blood Pressure Variability in Cerebrovascular Emergencies Consortia, consisting of a multidisciplinary group of experts in stroke, neurocritical care, perioperative medicine, emergency medicine, and clinical pharmacy to assess the clinical impact of BPV and to develop a working consensus on defining BPV, identifying interventions to mitigate negative outcomes from increased BPV, and laying the groundwork for BPV research concepts in the future.

Intraoperative Goal-Directed Fluid Therapy and Outcomes After Oncologic Surgeries: A Systematic Review and Meta-Analysis.

Background: Surgery is the first-line curative treatment for most solid-organ malignancies. During major surgeries, fluid under- or over administration can have a significant impact on recovery and postoperative outcomes. For patients undergoing oncologic surgery, delayed recovery or complications could additionally impact subsequent oncologic treatment planning.

Glial Modulator Antibiotics for Neuropathic Pain: Current Insights and Future Directions.

Pathological pain is defined as pain that outlives its usefulness as a protective warning system and becomes debilitating, disrupting normal life function. Understanding the mechanism of transition from physiological to pathological pain is essential to provide the effective prevention of chronic pain. The main subcategories of pathological pain are nociceptive pain, neuropathic pain, and nociplastic pain.

Perioperative Considerations of Novel Antidiabetic Agents in Heart Failure Patients Undergoing Cardiac Surgery.

Diabetes mellitus (DM) is a major risk factor for cardiovascular disease, including heart failure (HF). A high proportion of DM patients eventually require cardiac surgery. While the traditional approach to DM therapy focuses on tight glucose control with insulin and oral hypoglycemic agents, novel antidiabetic drugs have emerged over the past two decades that offer not only improved glycemic control but also cardiovascular and renal protection, such as benefits in HF management.

Evaluating Remimazolam for Procedural Sedation.

Remimazolam, a novel short-acting benzodiazepine, has garnered interest in the realm of procedural sedation. Targeting a desired level of sedation requires a medication with both anesthetic and analgesic properties, particularly in non-operating room anesthetizing locations. Via gammaaminobutyric acid type A receptor agonism, Remimazolam has demonstrated organ-independent metabolism and rapid time to both onset and recovery and has efficacy for procedural sedation in clinical trials.

Drugs in Development to Manage Acute Pain.

Acute pain, defined as short-term pain arising from injury or other noxious stimuli, affects patient outcomes, quality of life, and healthcare costs. Safe, effective treatment of acute pain is essential in preventing increased morbidity, mortality, and the transition to chronic pain. In this review, we explore some of the latest therapeutic agents, formulations, combinations, and administration routes of drugs emerging in clinical practice in the USA for the treatment of acute pain.

Role of Point-of-Care Gastric Ultrasound in Advancing Perioperative Fasting Guidelines.

Pulmonary aspiration in the perioperative period carries the risk of significant morbidity and mortality. As such, guidelines have been developed with the hopes of minimizing this risk by recommending fasting from solids and liquids over a specified amount of time. Point-of-care ultrasound has altered the landscape of perioperative medicine; specifically, gastric ultrasound plays a pivotal role in perioperative assessment.

Necrotizing Enterocolitis and Neurodevelopmental Impairments: Microbiome, Gut, and Brain Entanglements.

There is significant communication and interdependence among the gut, the microbiome, and the brain during development. Diseases, such as necrotizing enterocolitis (NEC), highlight how injury to the immature gastrointestinal tract leads to long-term neurological consequences, due to vulnerabilities of the brain in the early stages of life. A better understanding of the developing gut-microbiota-brain axis is needed to both prevent and treat the devastating consequences of these disease processes.

Dysmenorrhea, a Narrative Review of Therapeutic Options.

Dysmenorrhea is the most common pathology women of childbearing age face. It is defined as painful uterine cramping associated with menstruation. Primary dysmenorrhea occurs in the absence of an organic cause, whereas secondary dysmenorrhea is pelvic pain associated with an underlying pelvic pathology.

Start Strong, Finish Strong: A Review of Prehabilitation in Cardiac Surgery.

Cardiac surgery constitutes a significant surgical insult in a patient population that is often marred by significant comorbidities, including frailty and reduced physiological reserve. Prehabilitation programs seek to improve patient outcomes and recovery from surgery by implementing a number of preoperative optimization initiatives. Since the initial trial of cardiac prehabilitation twenty-four years ago, new data have emerged on how to best utilize this tool for the perioperative care of patients undergoing cardiac surgery.

Dementia after Ischemic Stroke, from Molecular Biomarkers to Therapeutic Options.

Ischemic stroke is a leading cause of disability worldwide. While much of post-stroke recovery is focused on physical rehabilitation, post-stroke dementia (PSD) is also a significant contributor to poor functional outcomes. Predictive tools to identify stroke survivors at risk for the development of PSD are limited to brief screening cognitive tests.

Impact of Diabetes Mellitus on Outcomes in Patients with Left Ventricular Assist Devices.

Heart failure (HF) represents a significant health burden in the United States, resulting in substantial mortality and healthcare costs. Through the array of treatment options available, including lifestyle modifications, medications, and implantable devices, HF management has evolved. Left ventricular assist devices (LVADs) have emerged as a crucial intervention, particularly in patients with advanced HF.

Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review.

Chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is a prevalent complication of joint replacement surgery which has the potential to decrease patient satisfaction, increase financial burden, and lead to long-term disability. The identification of risk factors for CPSP following TKA and THA is challenging but essential for targeted preventative therapy. Recent meta-analyses and individual studies highlight associations between elevated state anxiety, depression scores, preoperative pain, diabetes, sleep disturbances, and various other factors with an increased risk of CPSP, with differences observed in prevalence between TKA and THA.

Postoperative analgesic options after spine surgery: finding the optimal treatment strategies.

Introduction: Spine surgery is one of the most common types of surgeries performed in the United States; however, managing postoperative pain following spine surgery has proven to be challenging. Patients with spine pathologies have higher incidences of chronic pain and resultant opioid use and potential for tolerance. Implementing a multimodal plan for postoperative analgesia after spine surgery can lead to enhanced recovery and outcomes.

Clinical Diagnosis and Treatment of Chronic Pain.

More than 600 million people globally are estimated to be living with chronic pain. It is one of the most common complaints seen in an outpatient setting, with over half of patients complaining of pain during a visit. Failure to properly diagnose and manage chronic pain is associated with substantial morbidity and mortality, especially when opioids are involved.

Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial.

Background: Supplemental oxygen (SO) potentiates opioid-induced respiratory depression (OIRD) in experiments on healthy volunteers. Our objective was to examine the relationship between SO and OIRD in patients on surgical units.

Methods: This post-hoc analysis utilized a portion of the observational PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial dataset (202 patients, two trial sites), which involved blinded continuous pulse oximetry and capnography monitoring of postsurgical patients on surgical units.

The validity and applications of the analgesia nociception index: a narrative review.

Pain refers to the subjective, unpleasant experience that is related to illness or injury. In contrast to pain, nociception refers to the physiological neural processing of noxious stimuli, such as intra-operative surgical stimuli. One novel device, the Analgesia Nociception Index (ANI), aims to objectively measure intra-operative nociception by analyzing the heart rate variability in patients undergoing surgery.

Frailty: the perioperative and anesthesia challenges of an emerging pandemic.

Frailty is a complex and multisystem biological process characterized by reductions in physiological reserve. It is an increasingly common phenomena in the surgical population, and significantly impacts postoperative recovery. In this review, we will discuss the pathophysiology of frailty, as well as preoperative, intraoperative, and postoperative considerations for frailty care.

[. A shared responsibility. Gas capture and recycling project at the Cruces University Hospital (Spain)].

Objective: The use of volatile anesthetics plays an important role in the production of greenhouse gases and other environmental pollutants that negatively affect global health. Programs to reduce anesthesia contaminants have been shown to be effective and reduce costs. For this reason, we conducted a study to implementing a for zero carbon dioxide emissions derived from anesthetic gases used in the operating room, as recommended by the by 2030 and be climate neutral in 2050, maintaining satisfaction and current clinical results.