Current opinion in anaesthesiology
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Approximately 30% of the general surgical population presents with obesity, and the perioperative implications remain concerning. This review provides recent insights regarding morbid obesity and perioperative complications. ⋯ Further research and evidence are needed for the development of accepted perioperative pathways to address obesity and related comorbidities including sleep disordered breathing and metabolic syndrome as well as evidence-based strategies to reduce surgical infections. Rather than BMI alone, an improved index for obesity risk assessment is needed.
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Curr Opin Anaesthesiol · Feb 2016
ReviewGoal-directed therapy in the operating room: is there any benefit?
This article reviews the current evidence behind goal-directed therapy (GDT) in multiple medical settings. ⋯ The use of GDT may be beneficial depending on the clinical setting, but more evidence supporting its use is necessary before it can be considered standard of care.
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Cardiac surgery is associated with a wide range of microvascular derangements and with reduced tissue oxygenation. Although the macrohemodynamical targets during surgery may be achieved, the microcirculation may be damaged and remain dysfunctional. Direct observations of the microcirculation may enable more physiologically based approaches for diagnosis and treatment during cardiac surgery. ⋯ Direct visualization of the microcirculation using hand-held microscopy may provide the clinician the physiological feedback that is required for the early diagnosis and treatment of microcirculatory alterations during cardiac surgery. The coherence between the hemodynamic response of the macrocirculation and microcirculation during surgery seems to be essential.
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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.
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The present review highlights recent findings on perioperative systolic heart failure. It briefly summarizes the pathophysiology of heart failure and provides the reader with new insight in diagnosis and treatment of systolic heart failure. In addition, we review new therapeutic strategies with pharmacologic agents and mechanical assist devices to treat systolic heart failure. ⋯ Recent advances in the field of cardiovascular anesthesiology comprise advanced use of perioperative echocardiography, mechanical circulatory assist devices, and customized pharmacologic management.