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Anaesthesia for elite athletes

BACKGROUND

Sports participation has been growing rapidly since the 1960s. Anaesthesiologists are increasingly confronted with athletes in a peri-operative setting. The right choice of type of anaesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation.

PURPOSE

This review aims to give an overview of athletes' specific anaesthetic management in peri-operative and postoperative settings and to guide the nonspecialised anaesthetist.

METHODS

We comprehensively reviewed the literature, gathered all the information available on, and synthesised it in a narrative way, regarding preoperative evaluation, intraoperative implications and postoperative pain management of the elite athlete undergoing a surgical procedure.

RESULTS

An anaesthesiologist should recognise the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarisation as normal features in the athlete's heart. Isotonic physiology typically produces four-chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Pre-operative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anaesthesiologist is mainly avoiding drugs on the prohibited list of the World Anti-Doping Agency (WADA). Postoperative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, injectable NSAIDs and local anaesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialised multidisciplinary pain clinics.

CONCLUSION

This literature review aims to serve as a guide for the anaesthesiologist taking care of the elite athlete.

The Recognition Method of Athlete Exercise Intensity Based on ECG and PCG

Athletes usually arrange their training plans and determine their training intensity according to the coach's experience and simple physical indicators such as heart rate during exercise. However, the accuracy of this method is poor, and the training plan and exercise intensity arranged according to this method can easily cause physical damage, or the training cannot meet the actual needs. Therefore, in order to realize the reasonable arrangement and monitoring of athletes' training, a method of human exercise intensity recognition based on ECG (electrocardiogram) and PCG (Phonocardiogram) is proposed. First, the ECG and PCG signals are fused into a two-dimensional image, and the dataset is marked and divided according to the different motion intensities. Then, the training set is trained with a CNN (convolutional neural network) to obtain the prediction model of the neural network. Finally, the neural network model is used to identify the ECG and PCG signals to judge the exercise intensity of the athlete, so as to adjust the training plan according to the exercise intensity. The recognition accuracy of the model on the dataset can reach 95.68%. Compared with the use of heart rate to detect the physical state during exercise, ECG records the total potential changes in the process of depolarization and repolarization of the heart, and PCG records the waveform of the beating sound of the heart, which contains richer feature information. Combined with the CNN method, the athlete's exercise intensity prediction model constructed by extracting the features of the athlete's ECG and PCG signals realizes the real-time monitoring of the athlete's exercise intensity and has high accuracy and generalization ability.

Sudden Death and Ventricular Arrhythmias in Athletes: Screening, De-Training and the Role of Catheter Ablation

Athletes enjoy excellent health outcomes including greater longevity relative to non-athletic counterparts. Paradoxically, however, endurance athletic conditioning is associated with an increase in some arrhythmias. This review discusses the potential mechanisms for this paradox and strategies enabling early identification of potentially serious pathologies. Screening remains contentious due to the challenges of identifying relatively rare entities amongst a healthy cohort. The imperfect diagnostic accuracy of all current tests means that screening strategies have potential for harm through incorrect diagnoses as well as the potential for identification of important sub-clinical pathologies. Management of athletes at risk of ventricular arrhythmias and sudden cardiac death is similarly complex. There is much yet to learn about the specific patterns of ventricular arrhythmias in athletes, and the separation of benign from potentially life-threatening remains imperfect. There are some promising advances, however, such as specialised imaging modalities combined with improved electrophysiological diagnostics and therapeutics. Some unique clinical patterns are emerging to advance our understanding and management of athletes with ventricular arrhythmias, requiring specialised skillsets for evaluation and management.