Current opinion in anaesthesiology
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To survey the causes of ventilator-induced lung injury focusing on its mechanical determinants, lung stress and strain. ⋯ When lung protective strategy is considered unsafe, various techniques of extracorporeal respiratory support may be applied, which by decreasing the load of mechanical ventilation, allow partial to total lung rest.
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Anaesthesiologists have a significantly higher frequency of substance abuse by a factor of nearly 3 when compared with other physicians. This is still a current problem that must be reviewed. ⋯ As drug abuse among anaesthesiologists has continued, new studies have been conducted to know the theories about susceptibility. Written substance abuse policies and controls must be taken in place and in all countries.
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Curr Opin Anaesthesiol · Apr 2012
ReviewPlasma/platelets/red blood cell ratio in the management of the bleeding traumatized patient: does it matter?
The scope of this review is to describe what is known about blood product ratios and their effects on acute trauma coagulopathy. Assessing how ratios matter to trauma patients is important to improve massive transfusion strategies. ⋯ Fresh frozen plasma/platelet/red blood cell ratios matter to define the content of packs immediately available within the golden hour to the right, accurately screened trauma patients. Research is needed in developing novel transfusion approaches for massively bleeding patients.
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Sugammadex belongs to a new class of drugs termed selective relaxant binding agents and is now available for clinical use in over 50 countries. Because of its innovative mechanism of action, reversal of rocuronium or vecuronium becomes independent of the degree of residual neuromuscular blockade. Deep or intense neuromuscular blockade now can rapidly and predictably be reversed. However, compared with the classical acetylcholine esterase inhibitor-based reversal treatment costs are significantly higher. On the basis of the current literature, the cost-effectiveness of sugammadex will be evaluated. ⋯ The reduction of recovery times with sugammadex will reduce the incidence of prolonged extubation and may increase patients' throughput. However, the achievable reduction of costs depends on the individual organizational factors, also.
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Curr Opin Anaesthesiol · Apr 2012
ReviewCardiopulmonary exercise testing: does it improve perioperative care and outcome?
We reviewed recent articles, guidelines, and meta-analyses concerning the use of cardiopulmonary exercise testing (CPET) in preoperative risk evaluation and fitness for surgery. When the risk of surgery mortality is high (e.g. >5%), and/or the preoperative state of the patient indicates increased propensity toward morbidity and mortality (advanced age, presence of cardiovascular risk factors, multisystem disease, poor functional status, and so on), the thoroughness of the perioperative assessment should be intensified beyond the standard history and physical, basic laboratories, and electrocardiogram stress testing to include CPET. ⋯ Using a small number of important variables obtained from CPET an accurate picture of the patient's future response to perioperative stress can be obtained. Consideration should be given to performing a CPET in any preoperative patient who has increased risk or is scheduled to undergo a high risk surgical intervention. This strategy assists the anesthetist, surgeon, patients, and their families in appropriate perioperative planning.