Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2009
ReviewMicrocirculation and mitochondria in sepsis: getting out of breath.
To present the recent findings obtained in clinical and experimental studies examining microcirculatory alterations in sepsis, their link to mitochondrial dysfunction, and current knowledge regarding the impact of these alterations on the outcome of septic patients. ⋯ Even though there is evidence that microcirculatory and mitochondrial dysfunction plays a role in the development of sepsis-induced organ failure, their interaction and respective contribution to the disease remains poorly understood. Future research is necessary to better define such relationships in order to identify therapeutic targets and refine treatment strategies.
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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
ReviewLink between coagulation abnormalities and microcirculatory dysfunction in critically ill patients.
The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion. ⋯ The activation of coagulation may play an indirect role in microvascular dysfunction, through interplay with endothelium and inflammation.
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Curr Opin Anaesthesiol · Apr 2009
ReviewAnesthetic process, organization, management and economic issues: the French perspective.
Anesthesia is a three-step process: preoperative evaluation, the intervention itself and postanesthetic care. In France, this scheme has been legally regulated since 1994. Since then, significant progress has been made in terms of safety. Nevertheless, challenges in the delivery and financing of anesthesia services persist; in particular, demographic (patients and medical staff, as in other western countries), budgetary and organizational restrictions. ⋯ Paths to improvement of delivery of anesthesia in France may include: more optimal sharing of medical resources; better utilization of operating sites, perhaps by consolidating and reducing locations; applying improved organizational skills; and improved risk management.
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Curr Opin Anaesthesiol · Apr 2009
ReviewImproving safety in the operating room: a systematic literature review of retained surgical sponges.
Gossypibomas are surgical sponges that are unintentionally left inside a patient during a surgical procedure. To improve this patient safety indicator, anesthesiologists will need to work with operating room personnel. This study's goal was to systematically review the literature on retained sponges to identify body location, time to discovery, methods for detection, and risk factors. ⋯ More is being discovered about the patterns leading to a retained sponge. Multidisciplinary approaches and new technologies may help reduce this low frequency but clinically significant event. However, given the complexity of surgical care, eliminating retained sponges may prove elusive.