Current opinion in anaesthesiology
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The purpose of this review is to evaluate new concepts in mechanical ventilation in trauma. We begin with the keystone of physiology prior to embarking on a discussion of several new modes of mechanical ventilation. We will discuss the use of noninvasive ventilation as a mode to prevent intubation and then go on to airway pressure release ventilation, high-frequency oscillatory ventilation, and computer-based, closed loop ventilation. ⋯ The old modes of continuous positive airway pressure and bilevel positive airway pressure have been actively introduced in clinical practice in the case of trauma patients. Used with proper pain management protocols, there has been a decrease in the incidence of intubation in blunt thoracic trauma. Airway pressure release ventilation has been gaining a role in the management of thoracic injury and may lead to less incidence of physiologic trauma to mechanically ventilated patients. High-frequency oscillatory ventilation has been shown to be effective in patient care by its ability to open and recruit the lung in trauma patients and in those with acute respiratory distress syndrome but it may not have a role in patients with inhalational injury. Closed loop ventilation is a technology that may better control major pulmonary parameters and lead to more rapid titration from the ventilator to spontaneous breathing.
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Curr Opin Anaesthesiol · Apr 2010
ReviewFuture opportunities and challenges in academic anesthesia in the United Kingdom: a model for maintaining the scientific edge.
This review outlines the methodology of a major report into academic strategy recently undertaken by the Royal College of Anaesthetists in the United Kingdom. Analyzing the factors that made the report's conclusions robust and workable provides lessons for other countries or healthcare systems faced with similar problems in academic anesthesia. ⋯ The review's main conclusions are: the creation of a central National Institute for Academic Anaesthesia to coordinate and implement academic strategy and funding; engaging with national pathways for the training of future academics; and suggestions for the future role for anesthetic specialist societies in academic strategy. These initiatives can radically transform the research environment in a positive way.
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Curr Opin Anaesthesiol · Apr 2010
ReviewRespiratory failure and hypoxemia in the cirrhotic patient including hepatopulmonary syndrome.
Liver cirrhosis and portal hypertension present with three unique pulmonary complications that are the subject of ongoing clinical research: hepatopulmonary syndrome, portopulmonary hypertension (POPH), and hepatic hydrothorax. The present article is based on a review of the current literature on how to manage these disorders, which are highly important to both anesthesiologists and intensive care physicians. ⋯ Patients with end-stage liver disease are at risk for respiratory failure and hypoxemia and need to be screened for hepatopulmonary syndrome, POPH, and hepatic hydrothorax. Failure to timely recognize and adequately treat these complications of cirrhosis may have severe consequences.
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The present review examines the trends and controversies on how perioperative care can influence outcome after anesthesia and surgery. ⋯ The use of a surgical checklist may reduce postoperative mortality and complications in surgical patients. The optimal dosing and timing of perioperative beta-blockade should decrease the incidence of postoperative stroke. However, to date, the long-term risk:benefit balance of attenuation of the perioperative stress response remains controversial. Red cell transfusion is unavoidable in some cases, but is associated with worsened outcome in various surgical situations. Future research should focus on the risk:benefit balance of anesthesia and surgery. This will contribute to promoting the role of anesthesiologists as physicians of the perioperative period.
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The primary purpose of this article is to highlight the latest airway research in multitrauma. ⋯ Risks and benefits of ultimate prehospital airway control is a controversial topic. Utilization of videolaryngoscopes in multitrauma remains open for research. Standardization of training requirements, equipment, and development of prehospital and in-hospital airway algorithms are needed to improve outcomes. Rational utilization of available airway devices, development of new devices, or both may help to promote this goal.