Journal of clinical anesthesia
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Review Case Reports
Acute, unanticipated, and prolonged superior vena cava occlusion during pneumonectomy.
Acute, unanticipated superior vena cava (SVC) occlusion during thoracic surgery can have profound hemodynamic consequences and lead to devastating neurologic injury. We describe the successful anesthetic management of a pneumonectomy complicated by prolonged intraoperative SVC occlusion lasting a total of 290 minutes. To our knowledge, this represents the longest reported SVC occlusion time with no subsequent neurologic sequelae. Based on our favorable outcome and a review of the relevant literature, we offer a discussion of strategies for anesthetic management.
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Anesthetic gases have been used for a long time. Adverse effects of anesthetic gases to occupationally exposed people have been well documented in the literature. Due to low solubility, these gases are rapidly eliminated from the human body. Nevertheless, neurotoxic, immunosuppressive, hepatotoxic and reproductive toxicological effects have been shown in many of the scientific works. However, there is no detailed systematic bio-monitoring review about genotoxicity risk among occupationally exposed people. We herein performed systematic review based on relevant studies. ⋯ Health care workers are exposed to wide variety of agents including biological, physical and chemical factors. Among them anesthetic gases seems to be deserve special attentions since their genotoxic, mutagenic activities. In addition, chronic exposure to all anesthetic gases instead of alone induces cumulative genotoxic effects.
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Anesthetic gases have been used for a long time. Adverse effects of anesthetic gases to occupationally exposed people have been well documented in the literature. Due to low solubility, these gases are rapidly eliminated from the human body. Nevertheless, neurotoxic, immunosuppressive, hepatotoxic and reproductive toxicological effects have been shown in many of the scientific works. However, there is no detailed systematic bio-monitoring review about genotoxicity risk among occupationally exposed people. We herein performed systematic review based on relevant studies. ⋯ Health care workers are exposed to wide variety of agents including biological, physical and chemical factors. Among them anesthetic gases seems to be deserve special attentions since their genotoxic, mutagenic activities. In addition, chronic exposure to all anesthetic gases instead of alone induces cumulative genotoxic effects.
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Review
Perioperative fluid therapy: defining a clinical algorithm between insufficient and excessive.
In the perioperative scenario, adequate fluid and volume therapy is a challenging task. Despite improved knowledge on the physiology of the vascular barrier function and its respective pathophysiologic disturbances during the perioperative process, clear-cut therapeutic principles are difficult to implement. Neglecting the physiologic basis of the vascular barrier and the cardiovascular system, numerous studies proclaiming different approaches to fluid and volume therapy do not provide a rationale, as various surgical and patient risk groups, and different fluid regimens combined with varying hemodynamic measures and variable algorithms led to conflicting results. This review refers to the physiologic basis and answers questions inseparably conjoined to a rational approach to perioperative fluid and volume therapy: Why does fluid get lost from the vasculature perioperatively? Whereto does it get lost? Based on current findings and rationale considerations, which fluid replacement algorithm could be implemented into clinical routine?
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As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. ⋯ In this review, we will discuss the most commonly used anticoagulants used in outpatient settings and discuss their management in the perioperative period. Special considerations for regional anesthesia and interventional pain procedures will also be reviewed.