Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2014
ReviewManagement of right ventricular dysfunction in the perioperative setting.
This review summarizes the approach to and recent developments in the treatment of acute right ventricular dysfunction and failure in the perioperative setting. Right ventricular failure, defined as the inability to deliver sufficient blood flow through the pulmonary circulation at normal central venous pressure, is a common problem in the perioperative setting and is associated with an increased mortality. The failure of the right ventricle is caused by reduced right ventricular contractility or an increased right ventricular afterload or both. ⋯ Right ventricular dysfunction may cause venous congestion and systemic hypoperfusion. After identifying right ventricular dysfunction, the primary goal is to correct reversible causes of excessive load or reduced right-ventricular contractility. If the underlying abnormalities cannot be reversed, diuretic, vasodilator, or inotropic therapy may be required.
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Curr Opin Anaesthesiol · Aug 2014
ReviewIntraoperative MRI for neurosurgical and general surgical interventions.
The use of intraoperative magnetic resonance imaging (IMRI) during surgeries and procedures has expanded in the last decade. Not only is it becoming more commonly used for a variety of adult and pediatric neurosurgical procedures, but also its use has expanded to other types of surgeries. Along with using IMRI for removing tumors of the spinal cord, surgeons are now using it for other types of surgical operations of the kidney and liver. The increased utilization during the intraoperative period warrants the anesthesia provider to assure that patients and staff are unharmed because of increased risk of the powerful magnet. ⋯ IMRI is becoming increasingly more popular, especially with neurosurgeons, but its use is also expanding to other types of surgeries. Because of the increased use, the anesthesia provider must be aware of the dangers that it imposes to those involved and take necessary safety precautions. This will help assure that no one is harmed during the operation or procedure.
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To discuss the recent advances in sedation and anesthesia for the practice of both flexible and rigid bronchoscopy, which are increasingly performed outside of the operating room by interventional pulmonologists and thoracic surgeons. ⋯ As our practice expands, relocation of appropriately triaged pulmonary interventional procedures including rigid bronchoscopy that were previously assigned to a traditional operating room setting improves provider flexibility, presents more cost-effective options while maintaining patient safety and satisfaction and reducing the time to recovery. Anesthesia practice has, therefore, shifted to caring for these sick patients outside the operating room and increasingly cooperation between anesthesiologist and proceduralist is required.
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Curr Opin Anaesthesiol · Aug 2014
ReviewAnesthesia in neurologic and psychiatric diseases: is there a 'best anesthesia' for certain diseases?
Patients with diseases affecting the central nervous system present a wide range of clinical manifestations increasing the perioperative risk. The following review focused on recommendations for anaesthesiological management in patients with both neurologic and psychiatric diseases. ⋯ The 'best' anesthesia includes adequate preoperative evaluation of the individual risk, optimization of comorbidities before elective surgery, the use of short-acting anesthetic agents for induction and maintenance of general anesthesia, avoidance of volatile agents and succinylcholine in muscular dystrophy and myopathies.
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In the last decade, there has been a rapid development in new endovascular treatment options for cerebral aneurysms. These techniques have their own inherent risk and can be challenging for the attending anesthetist. ⋯ The different endovascular techniques relevant to the anesthetist, the anesthetic options and complications that can occur during endovascular treatment of these patients will be discussed. This article can be a guidance to the anesthesiologist attending endovascular procedures for cerebral aneurysms.