Current opinion in anaesthesiology
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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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The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) continues to increase and is associated with significant morbidity and mortality. Early diagnosis and identification of patients at risk are extremely important. Therefore, identifying associated risk factors, biomarkers for earlier detection, prevention and therapeutic options for CS-AKI warrant special attention. ⋯ It is extremely important to identify those who are at increased risk for CS-AKI with the foremost goal being that of prevention to help decrease morbidity and mortality. Combining functional and tubular biomarkers can assist with early identification. Once identified, early interventions including avoidance of nephrotoxins, decreasing cardiopulmonary bypass time, avoiding fluid overload and early initiation of renal replacement therapy may lead to improved clinical outcomes.
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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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As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications. ⋯ The review summarizes the procedures now commonly performed by interventional pulmonologists and interventional radiologists. It discusses the anesthetic considerations for and common complications of these procedures to prepare anesthesiologists to safely care for these patients. Investigational techniques are also described.
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This article reviews the technology and clinical data describing hemodynamic monitoring devices available to anesthesiologists and intensivists caring for patients undergoing thoracic surgical procedures, so that they may better utilize available technology to improve outcomes in this high-risk surgical population. ⋯ Technology that has been shown to improve clinical outcomes in major surgical procedures is likely applicable to patients undergoing thoracic surgical procedures; however, several unique features of these procedures limit or modify the way in which these devices can be used. Understanding the scientific basis of these devices is the key to using them effectively.