Current opinion in anaesthesiology
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Traumatic brain and spinal cord injuries continue to be a public health problem. These types of injuries often occur in early adulthood and have a major impact for society. This review discusses strategies and therapeutic agents for perioperative neuroprotection in the management of brain and spinal cord trauma. ⋯ The main priority in the initial treatment of brain and spinal cord trauma is to maintain oxygenation and perfusion in order to avoid aggravating secondary injury. Future progress will depend on the translation of neuroprotective strategies into well designed clinical trials with promising outcomes.
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This review provides a practical overview of the performance capabilities of automatic external defibrillators (AEDs), and of advances in technology and dissemination programmes for these devices. ⋯ Given the correct setting, AEDs can ensure that defibrillation is not limited by lack of medical knowledge or difficulties in decision making. However, event-related variables and operator-related factors, that are yet to be determined, can significantly affect the efficacy of automatic external defibrillation.
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Most patients who suffer a cardiac arrest die after the event. Full neurological recovery occurs in only 6-23%. Until recently no specific post-arrest therapy was available to improve outcome. Application of therapeutic hypothermia (32-34 degrees C for 12-24 h) applied after cardiac arrest could help to improve this dreadful situation. This review covers the background of and recent clinical studies into hypothermia after cardiac arrest, and gives some insights into the future of resuscitation, namely suspended animation. ⋯ The introduction of therapeutic hypothermia after cardiac arrest into routine intensive care practice could save thousands of lives worldwide, because only six patients must be treated to yield one additional patient with favourable neurological recovery. New developments in cooling techniques will make early induction of therapeutic hypothermia simple and convenient. The optimal duration and depth of hypothermia will be determined by future trials. Suspended animation is cooling during cardiac arrest to preserve the organism under conditions of prolonged controlled clinical death, followed by delayed resuscitation, resulting in survival without brain damage. This concept was initially introduced for trauma victims who rapidly bleed to death, and proved to be feasible in studies evaluating outcomes following exsanguination cardiac arrest in large animals. Whether the concept of suspended animation is applicable to normovolemic cardiac arrest is under investigation.
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The review focuses on six papers published in 2004 that pertain to operating room (OR) efficiency. ⋯ Interventions studied included changing when OR time was released, reducing surgical times, reducing turnover times, reducing OR times with block rooms, and improving prediction of case duration. The incremental improvements in OR efficiency and reductions in labor costs were small as compared with allocating OR time and scheduling cases appropriately.
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Curr Opin Anaesthesiol · Apr 2005
Acute respiratory distress syndrome: update on the latest developments in basic and clinical research.
Acute lung injury/acute respiratory distress syndrome is a common, serious condition affecting a heterogeneous population of critically ill patients. Other than low tidal volume ventilation, no specific therapy has improved survival. Understanding the epidemiology, pathogenesis, and lessons to be learned from previous clinical trials is necessary for the development of new therapies and the rational design of studies assessing their efficacy. ⋯ The results of recent clinical trials have raised more questions. Further study of the inflammatory response, surfactant regulation, and the cellular impact of mechanical ventilation should help to develop new therapies, target patients most likely to benefit, and identify appropriate timing of intervention.