Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2017
ReviewMortality and cost of acute and chronic kidney disease after cardiac surgery.
Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. ⋯ AKI and CKD remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.
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Curr Opin Anaesthesiol · Feb 2017
ReviewPreoperative evaluation and preparation of the morbidly obese patient.
This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. ⋯ Synthesis of proper medical history-taking and physical examination as well as detailed search for obstructive sleep apnea and metabolic syndrome are key components of preoperative evaluation. Further testing should be based on the findings of these steps and comprise the cardiac risk of the surgical procedure.
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Curr Opin Anaesthesiol · Feb 2017
ReviewSleep, sleep studies and sleep-disordered breathing: basic knowledge for the anesthesiologist.
To provide a basic understanding of sleep physiology, the pathophysiology of sleep-disordered breathing and the processes applied in undertaking and assessing sleep studies. ⋯ This review describes the physiology of sleep including sleep stages, sleep monitoring, the normal hypnogram and investigation from simple overnight pulse oximetry to full polysomnography. The pathophysiology of sleep-disordered breathing is discussed; from simple snoring through obstructive sleep apnoea to obesity hypoventilation syndrome. The relationship to metabolic syndrome is explored.Salient points in the interpretation of sleep study reports are presented.
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Curr Opin Anaesthesiol · Feb 2017
ReviewLung regeneration: steps toward clinical implementation and use.
Whole lung tissue engineering is a relatively new area of investigation. In a short time, however, the field has advanced quickly beyond proof of concept studies in rodents and now stands on the cusp of wide-spread scale up to large animal studies. Therefore, this technology is ever closer to being directly clinically relevant. ⋯ Ultimately, the goal of the research described herein is to create a useful clinical product. In the intermediate time, however, the tools described here may be employed to advance our knowledge of lung biology and the organ-specific regenerative capacity of lung stem and progenitor cells.
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The applications for extracorporeal membrane oxygenation for lung support are constantly evolving. This review highlights fundamental concepts in extracorporeal lung support and describes directions for future research. ⋯ Extracorporeal lung support is a safe and an easily implemented intervention for refractory respiratory failure. Recent advances have extended its use beyond acute illnesses and the developments for chronic support will facilitate the development of durable devices and possible artificial lung development.