Current opinion in anaesthesiology
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Anesthesia care for patients undergoing ambulatory gynecologic surgery has improved incrementally over the past few years. Emphasis has evolved beyond the safe provision of care, because this has largely been achieved. Comfort, speed, and efficiency have taken on new importance. ⋯ Local anesthetic use in gynecologic laparoscopy appears to improve postoperative pain control modestly, especially when given into the peritoneal cavity. Supralaryngeal airways, such as ProSeal LMA, appear to provide effective ventilation in laparoscopy, although their ability to protect against aspiration is unclear. The speed and comfort of emergence, recovery, and discharge may be improved by consciousness monitoring during general anesthesia and by drugs intended to modulate hemodynamics.
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Cancer is beginning to outpace cardiovascular disease as the primary cause of death in the developed world. A majority of cancer patients will require anaesthesia either for primary debulking tumour removal or to treat an adverse consequence of the malignant process or its treatment. Therefore we outline here the pathophysiology of cancer, generalized metastatic disease and systemic chemotherapy and radiotherapy on major organ systems. The anaesthetic considerations for optimum perioperative management of cancer patients are discussed, and the possibility of anaesthetic technique at primary cancer surgery affecting long-term cancer outcome is mentioned. ⋯ Optimum perioperative patient care requires individual assessment of the impact of cancer and its treatment on the functional reserve of all major organ systems. The potential of anaesthetic technique at cancer surgery to influence long-term cancer outcome merits investigation.
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There are several commercially available electroencephalogram-derived devices for monitoring anaesthesia depth. This article reviews all published studies describing their use in children; first assessing studies of performance in measuring anaesthesia depth in observational, physiological studies and then describing relevant outcome studies. There is also a brief discussion of why they might be useful, what physiological problems may arise and what the reader should be wary of in the methodology of these studies. The subject is approached from a clinical perspective. ⋯ The bispectral index is the most widely studied, but at this stage there is no evidence to suggest any one device is substantially superior to any other. There may be a role emerging for their use in older children, but their use in infants cannot be supported.
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Curr Opin Anaesthesiol · Jun 2007
ReviewManagement of patients with cardiac stents undergoing noncardiac surgery.
Coronary stenting is performed in over 4 million patients annually. Approximately 5% of these patients undergo a noncardiac surgical procedure within 1 year after stenting. Surgery might induce hypercoagulability. This causes increased concern about the effects of previous coronary stenting on postoperative cardiac outcome, particularly in-stent thrombosis. On the other hand, patients with multiple cardiac risk factors are at high risk for postoperative adverse cardiac events and might even benefit from preoperative prophylactic coronary revascularization. ⋯ Early noncardiac surgery after coronary stenting increases the risk of postoperative cardiac events. Interruption of antiplatelet therapy seems to play an important role in this increased event rate. Prophylactic coronary revascularization in cardiac stable, but high-risk patients does not seem to improve outcome.