Current opinion in anaesthesiology
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This paper aims to provide a condensed review of the most essential and current research findings in the field of acute lung injury over the past year. ⋯ Recent advances in our understanding of the pathogenesis of acute lung injury have provided the promise of exciting potential interventions to modify intravascular and extravascular fibrinogenesis, neutrophil activation and clearance, and alveolar fluid clearance. Our new understanding of prolonged disability and post-traumatic stress in acute lung injury survivors will ultimately change the standard for how these patients are managed in the intensive care unit and followed beyond their hospital stay.
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Perioperative hypothermia triples the incidence of adverse myocardial outcomes in high-risk patients; it significantly increases blood loss and augments allogeneic transfusion requirements. Even mild hypothermia increases the incidence of surgical wound infection following colon resection and therefore the duration of hospitalization. Hypothermia adversely affects antibody- and cell-mediated immune defenses, as well as the oxygen availability in the peripheral wound tissues. Mild perioperative hypothermia changes the kinetics and action of various anesthetic and paralyzing agents, increases thermal discomfort, and is associated with delayed postanesthetic recovery. ⋯ This article reviews recent publications in the field of accidental as well as therapeutic hypothermia, and tries to assess what evidence is available at the present time.
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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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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.