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The macro- and microcirculation of the kidney
Publication date: September 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 3Author(s): Philippe Guerci, Bulent Ergin, Can InceAcute kidney injury (AKI) remains one of the main causes of morbidity and mortality in the intensive care medicine today. Its pathophysiology and progress to chronic kidney disease is still under investigation. In addition, the lack of techniques to adequately monitor renal function and microcirculation at the bedside makes its therapeutic resolution challenging. In this article, we review current concepts related to renal hemodynamics compromise as being the event u...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: September 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 3Author(s): (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Renal replacement therapy for AKI: When? How much? When to stop?
Publication date: September 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 3Author(s): Stefano Romagnoli, William R. Clark, Zaccaria Ricci, Claudio RoncoSevere acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious clinical disorder in the intensive care unit (ICU), occurring in a significant proportion of critically ill patients. However, many questions remain about the optimal administration of RRT with regard to several important considerations, including treatment dose, timing of treatment initiation and cessation, therapy mode, type of anticoagulation, and man...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Opioids, respiratory depression, and sleep-disordered breathing
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Mahesh Nagappa, Toby N. Weingarten, Gaspard Montandon, Juraj Sprung, Frances ChungThe increasing use of opioids in the perioperative period has increased opioid-associated morbidity and mortality. There is a well-established connection between opioids, sleep-disordered breathing (SDB), and respiratory depression. The treatment of postoperative pain with opioids in patients with SDB may result in respiratory depression. In an unmonitored setting, it may lead to life-threatening respiratory events. More stud...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Opioid-free anesthesia opioid side effects: Tolerance and hyperalgesia
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Patricia Lavand'homme, Arnaud SteyaertOpioids are the most potent drugs used to control severe pain. However, neuroadaptation prevents opioids' ability to provide long-term analgesia and produces opposite effects, i.e., enhancement of existent pain and facilitation of chronic pain development. Neuroadaptation to opioids use results in the development of two interrelated phenomena: tolerance and “opioid-induced hyperalgesia” (OIH). Tolerance, a pharmacologic concept, and OIH, a clinical syndrome, have b...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Opioid-related side effects: Postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature
In conclusion, postoperative urinary retention, postoperative ileus, nausea and vomiting, and shivering are complex problems seen after surgery. Management is possible, but prevention is possible with the avoidance of high doses of intraoperative opioids, conjointly to opioid-sparing techniques. (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Additives used to reduce perioperative opioid consumption 1: Alpha2-agonists
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Peter H. TonnerBecause of their significant side effects, especially in obese patients, the routine perioperative use of opioids has been questioned recently. Alpha2-agonists are drugs with a considerable analgesic potency with the potential to reduce opioid consumption. Alpha2-agonists bind to alpha2-adrenergic receptors in the CNS and peripherally. They inhibit the central sympathetic outflow, resulting in an attenuation of blood pressure and heart rate and in a sparing effect on anaesthetics and analges...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Intravenous lidocaine
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Jean-Pierre EstebeLidocaine has analgesic effect and antihyperalgesic and anti-inflammatory properties, which enable its use as a general anesthetic adjuvant. Lidocaine can reduce nociception and/or cardiovascular responses to surgical stress, postoperative pain, and/or analgesic requirements. However, its mechanisms of action remain unclear, despite its different known properties. Although the exact mechanism of action remains uncertain, initial bolus followed by a continuous lidocaine infusion has clear ...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Stable anesthesia with alternative to opioids: Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials
ConclusionIn conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia. (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Eckhard Mauermann, Wilhelm Ruppen, Oliver BandschappWith increasing awareness of both short- and long-term problems associated with liberal perioperative opioid administration, the need for routinely and clinically feasible alternatives is greater than ever. Opioid-free anesthesia—previously reserved for bariatric surgery—is receiving increasing attention in mainstream anesthesia.In this review, we present the truly multimodal concept of opioid-free anesthesia, which circumvents a number of opioid-rela...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Special indications for Opioid Free Anaesthesia and Analgesia, patient and procedure related: Including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Adrian Sultana, David Torres, Roman SchumannOpioid-free anaesthesia (OFA) is a technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with the anaesthetic. Opioid-free analgesia similarly avoids opioids in the perioperative period.There are many compelling reasons to avoid opioids in the surgical population.A number of case reports and, increasingly, prospective studies from all over the world support its benefits, especially in the morbidly obese population with or w...
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Preface
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): Alexander Zarbock (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Editorial Board
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Publisher's note
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research

Opioid free general anesthesia, a new paradigm?
Publication date: December 2017Source: Best Practice & Research Clinical Anaesthesiology, Volume 31, Issue 4Author(s): J. Mulier, M. Dekock (Source: Best Practice and Research Clinical Anaesthesiology)
Source: Best Practice and Research Clinical Anaesthesiology - July 10, 2018 Category: Anesthesiology Source Type: research