Current opinion in anaesthesiology
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General recommendations for the perioperative management of patients with hypertensive disease have not evolved much over the past 20 years, yet new pathophysiological concepts have emerged and new monitoring techniques are available today. In this review, we will discuss their significance and potential role in the modern perioperative care of hypertensive patients. ⋯ Hypertension is highly prevalent in patients presenting for surgery yet its impact on surgical outcome is still debated. Guidelines on risk stratification and perioperative hemodynamic management of patients with hypertensive disease remain sparse and cannot rely much on solid new evidence. Target organ damage associated with hypertensive disease rather than high BP per se appears to determine perioperative risk. In the absence of new data, an individualized and pathophysiology-based approach to control BP may be the best option to guide these patients through the perioperative period.
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Curr Opin Anaesthesiol · Jun 2016
ReviewDoes major surgery induce immune suppression and increase the risk of postoperative infection?
Infection is the commonest cause of a postoperative complication. Following major surgery alterations in immune function are commonplace and these may contribute to an enhanced susceptibility to acquire nosocomial infections. This review will discuss postoperative infections in the context of an altered perioperative immune response and the factors influencing this response. ⋯ Point of care tests are emerging that allow monitoring of the perioperative immune response. These could be further developed to introduce personalised care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that may be associated with poor outcomes through immune modulation.
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Anemia remains a global health issue. This review addresses the recent findings on anemia in surgical patients and its significance in perioperative setting. ⋯ Active screening for anemia and proper management of it in perioperative setting is essential. Several strategies to prevent anemia - including elimination of unnecessary diagnostic blood draws - are effective and reasonable approaches.
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Purpose of review is to summarize and highlight recent advances in the management of pregnant patients with pulmonary hypertension. ⋯ Anesthesiologists involved in the management of pregnant patients with pulmonary hypertension must have detailed knowledge of pathophysiological alterations in pregnancy and during birth, cardiac (patho)physiology, cardiovascular and obstetric pharmacology, hemodynamic monitoring, and echocardiography. Both regional and general anesthesia have typical adverse effects that can severely jeopardize the cardiovascular system in patients with pulmonary hypertension, and should therefore be anticipated/prevented/rapidly treated by the attending anesthesiologist.
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Curr Opin Anaesthesiol · Jun 2016
ReviewThe impact of glycaemic variability on the surgical patient.
Diabetes is the most prevalent long-term metabolic condition and its incidence continues to increase unabated. Patients with diabetes are overrepresented in the surgical population. It has been well recognized that poor perioperative diabetes control is associated with poor surgical outcomes. The outcomes are worst for those people who were not recognized as having hyperglycaemia. ⋯ glycaemic control remains an important consideration in the surgical patient.