Current opinion in anaesthesiology
-
The mean age of patients presenting for thoracic surgery is rising steadily, associated with an increased demand for thoracic surgical treatments by geriatric patients. With increasing age, physiologic changes and comorbidities have to be considered. Thoracic anesthesia for elderly patients requires greater specific knowledge. ⋯ Considering key points of physiology and pharmacology can help to provide best possible care for the increasing number of elderly patients in thoracic surgery. Management of geriatric patients in thoracic surgery offer opportunities for anaesthetic interventions including protective ventilation, use of different anesthetics, anaesthesia monitoring, fluid management and pain therapy.
-
Curr Opin Anaesthesiol · Feb 2015
ReviewPreventive and therapeutic noninvasive ventilation in cardiovascular surgery.
Postoperative pulmonary complications are common after cardiac and vascular surgery, and they are associated with a marked worsening in hospital survival and length of stay. Noninvasive ventilation (NIV) has been successfully applied in the prevention and treatment of postoperative acute respiratory failure (ARF), including the cardiovascular setting. ⋯ NIV seems effective when applied to treat postoperative ARF. Its role as a preventive tool is still controversial, and probably should be limited to high-risk patients. Promising findings were reported for NIV application in pediatric patients and in ancillary procedures. So far, a cautious approach should be applied, as NIV failure is associated with poor outcomes if not quickly detected.
-
Curr Opin Anaesthesiol · Feb 2015
ReviewPerioperative myocardial perfusion: an anesthesiologists' concern?
General anesthesia has only small effects on myocardial perfusion in healthy patients.
pearl -
Curr Opin Anaesthesiol · Feb 2015
ReviewStrategies to reduce blood transfusion: a Latin-American perspective.
Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion. ⋯ An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
-
Acute kidney injury (AKI) is a long-recognized complication of cardiac surgery. It is a commonly encountered clinical syndrome that, in its most severe form, increases the odds of operative mortality three to eight-fold. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is complex. No single intervention is likely to provide a panacea, and thus, the purpose of this review is to assess the wide breadth of emerging research into potential strategies to prevent, diagnose, and treat CSA-AKI. ⋯ Although there has been much high-quality research conducted in this field in recent years, preventing CSA-AKI by avoiding renal insults remains the mainstay of management. Although biomarkers have the potential to diagnose CSA-AKI at an earlier stage, efficacious interventions to treat established CSA-AKI remain elusive.