Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2016
ReviewAre morbidly obese patients suitable for ambulatory surgery?
The incidence of morbid obesity continues to increase worldwide. Associated comorbidities, particularly obstructive sleep apnea, increase the perioperative morbidity for this group of patients. The purpose of this review is to discuss appropriate selection of morbidly obese patients for ambulatory surgery. ⋯ Recent evidence suggests that carefully selected morbidly obese patients can safely undergo surgery on an ambulatory basis. Individualized evaluations taking into account patient-related factors, surgery-related factors, and anesthesia-related factors should dictate which patients are appropriate for ambulatory surgery.
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Curr Opin Anaesthesiol · Feb 2016
ReviewPearls and pitfalls in managing right heart failure in cardiac surgery.
To review the recent insights in the evaluation and management of perioperative (RHF). ⋯ An integrated approach for assessing the cardiopulmonary axis combining imaging, hemodynamic and tissue perfusion monitoring is emerging, as particularly helpful in the field. Several developments in the field of temporary right heart support including the pumpless interventional lung assist membrane ventilator are offering new opportunities to support the right-heart pulmonary circulation. Future multicenter studies are needed to develop more effective preventive and therapeutic strategies for RHF.
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Curr Opin Anaesthesiol · Feb 2016
ReviewObstructive sleep apnea, pain, and opioids: is the riddle solved?
Perioperative opioid-based pain management of patients suffering from obstructive sleep apnea (OSA) may present challenges because of concerns over severe ventilatory compromise. The interaction between intermittent hypoxia, sleep fragmentation, pain, and opioid responses in OSA, is complex and warrants a special focus of perioperative outcomes research. ⋯ OSA may complicate opioid-based perioperative management of pain by altering both pain processing and sensitivity to opioid effect.