Current opinion in anaesthesiology
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Epidurals have been used for cardiac surgery for more than 20 years. The worldwide-published use is now large enough to determine that there is no additional risk for epidural use in cardiac versus noncardiac surgery. ⋯ Fear of an increased risk of epidural haematoma has largely prevented increased use of this technique for cardiac surgery. Clinicians can be reassured that the risk of epidural use in cardiac surgery is similar to that for noncardiac surgery, which provides a new platform for considering risk versus benefit in their practice.
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Curr Opin Anaesthesiol · Feb 2009
ReviewManagement of mini-cardiopulmonary bypass devices: is it worth the energy?
To address the role of mini-cardiopulmonary bypass systems in cardiac operations, with specific respect to clinical outcome. ⋯ Mini-cardiopulmonary bypass systems reduce the need for allogeneic blood transfusions. Other improvements in postoperative outcome are more debated. They require a long learning curve and are more expensive. A cost analysis based on a large randomized controlled trial is still needed to clarify the potential future role of these systems in clinical practice.
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The present review evaluates the evidence available in the literature tracking perioperative mortality and morbidity as well as the pathogenesis and management of acute lung injury (ALI) in patients undergoing thoracotomy. ⋯ Knowledge of the perioperative risk factors of major complications and understanding of the mechanisms of postthoracotomy ALI enable anesthesiologists to implement 'protective' lung strategies including the use of low tidal volume (VT) with recruitment maneuvers, a goal-directed fluid approach and prophylactic treatment with inhaled beta2-adrenergic agonists.