Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2009
ReviewApplying gases for microcirculatory and cellular oxygenation in sepsis: effects of nitric oxide, carbon monoxide, and hydrogen sulfide.
Nitric oxide, carbon monoxide, and hydrogen sulfide (H2S) are gases that have received attention as signaling molecules regulating many biological processes. All of them were reported to have beneficial effects in inflammatory states, in particular for microcirculatory perfusion and tissue energy balance. Thus, this review will highlight the most important results with a focus on resuscitated, clinically relevant experimental models and, if available, human studies. ⋯ It is still a matter of debate whether manipulating nitric oxide, carbon monoxide, or H2S tissue concentrations, either by using the inhaled gas itself or by administering donor molecules or inhibitors of their endogenous production, is a useful therapeutic approach to improve microcirculatory blood flow, tissue oxygenation, and cellular respiration. This is mainly due to their 'friend and foe character' documented in various experimental models, but also to the paucity of data from long-term, resuscitated large animal experiments that fulfil the criteria of clinically relevant models.
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Curr Opin Anaesthesiol · Apr 2009
ReviewCan anesthesia information management systems improve quality in the surgical suite?
To summarize developments related to the use of anesthesia information management systems (AIMS) and quality assurance and quality improvement. ⋯ Implementation of information technologies in anesthesia as well as in all aspects of healthcare redesigns how patients receive care. AIMS accurately measure, store, query, and recall vital sign data, and enable the systematic analysis of anesthesia-related perioperative data. Using AIMS, quality management programs will be able to study more incidents and analyze them more quickly. Ideally, decision-support systems with practice guidelines delivered via AIMS should help overcome the usual barriers to guideline adherence, and improve care and safety.
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Curr Opin Anaesthesiol · Apr 2009
ReviewCoagulopathy in trauma patients: what are the main influence factors?
Coagulopathy and bleeding after severe injury is a common problem. Whenever caring for critically ill patients, clinicians must anticipate, recognize and manage the coagulopathy of trauma. When left untreated, cardiovascular shock and multiorgan system failure ensue. Uncompensated hemorrhage often culminates in death, highlighting the significance of recognizing the main influences in coagulopathy of trauma. ⋯ Although mortality previously was thought to be summarily independent of medical interventions and resuscitations, we now know the opposite to be true; it is our expectation and indeed our obligation to recognize and manage the coagulopathy of trauma better than in past years. In as much as we continue to prevent acidosis, hypothermia and the progressive coagulopathy following injury, trauma victims the world over are benefiting and surviving longer, living proof that demonstrates the utility of managing the coagulopathy of trauma.
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Curr Opin Anaesthesiol · Apr 2009
ReviewCoagulopathy in trauma patients: importance of thrombocyte function?
Trauma-induced coagulopathy results from a complex interplay between shock resuscitation and impaired clotting protease function. A pathophysiological role of platelets in this condition remains as yet undefined. This review examines our current knowledge of platelet function in haemostasis, possible mechanisms for aberrant activity in trauma and the role of platelet transfusions in exsanguinating haemorrhage. ⋯ Platelets undoubtedly play a pivotal role in haemostasis and trauma-induced coagulopathy. However, their specific dysfunction in trauma remains to be elucidated. Further research to characterize the dysfunctional pathways of the platelet response is required, together with clinical trials of the optimal timing and dose of platelet transfusions.