Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2013
ReviewEthical considerations for discontinuing pacemakers and automatic implantable cardiac defibrillators at the end-of-life.
As the use of intracardiac devices has increased, the awareness of the burdens of the devices, especially the uncomfortable defibrillator shocks, has also increased. Some patients have requested device deactivation and some physicians have expressed reluctance to do so. This review will update physicians about the ethical acceptability of removal of intracardiac devices. ⋯ Physicians ought to initiate a deactivation conversation, ideally at the time of implantation. Sharing case studies about the deactivation process will enable physicians to enhance their ability to guide patients and family through thoughtful decision-making. Guidelines for deactivation should be promulgated throughout institutions that serve patients with intracardiac devices.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPredicting postoperative pulmonary complications in high-risk populations.
Our objective is to describe prediction models for surgical patients who have suspected obstructive sleep apnea (OSA) at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome (ARDS). ⋯ Evidence is emerging that early identification of modifiable risk factors and implementation of 'protective' management strategies may lead to reduction of severe postoperative pulmonary complications.
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Curr Opin Anaesthesiol · Apr 2013
ReviewDoes training with human patient simulation translate to improved patient safety and outcome?
In this review, we evaluate several articles in an attempt to qualify the effect of human patient simulation in anaesthesia on patient outcome. The recognition of medical error as a significant cause of patient morbidity and mortality has sparked an increased focus on improving healthcare quality and patient safety. Simulation in anaesthesia is a potential tool to help achieve this goal by allowing anaesthesia providers to learn, practice and perfect their craft without a potential harm to patients. It has gained growing traction in the field and is recently a required element in the American Board of Anesthesiology's Maintenance of Certification in Anesthesia programme. ⋯ Despite the adoption of simulation, further study is needed to better qualify its effect on patient safety and outcome.
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Curr Opin Anaesthesiol · Apr 2013
ReviewNonventilatory strategies to prevent postoperative pulmonary complications.
In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery. ⋯ Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPotential value of transfusion protocols in cardiac surgery.
On the one hand, cardiac and aortic surgery is associated with a high rate of allogeneic blood transfusion. On the other hand, both bleeding and allogeneic blood transfusion is associated with increased morbidity, mortality, and hospital costs in cardiac and aortic surgery. This article reviews the current literature between 1995 and 2012 dealing with transfusion protocols in cardiovascular surgery. The 16 studies fitting these search criteria have evaluated the impact of the implementation of ROTEM/TEG based coagulation management algorithms on transfusion requirement and outcome in overall 8507 cardiovascular surgical patients. ⋯ Implementation of POC algorithms including a comprehensive bundle of POC diagnostics (thromboelastometry and whole blood impedance aggregometry) in combination with first-line therapy using immediately available specific coagulation factor concentrates (fibrinogen and prothrombin complex concentrate) and defining strict indications, calculated dosages, and clear sequences for each haemostatic intervention seems to be complex but most effective in reducing perioperative transfusion requirements and has been shown to be associated with a decreased incidence of thrombotic/thromboembolic events, transfusion-related adverse events, as well as with improved patients' outcomes including 6-month mortality.