Current opinion in anaesthesiology
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Management of difficult airway is far from optimal despite of continuous progress in science and technology. The purpose of this review is to summarize the current research in the field and bring readers up to date. ⋯ Improvement of managing difficult airway relies on optimized mask ventilation, utilization of the appropriate tools for intubation, maximization of the safe apnea oxygenation time, prompt surgical airway in response to severe hypoxia in case effective noninvasive interventions are not achievable. It seems that a simplified and concise algorithm of difficult airway management needs to be established in order to enable providers to easily remember and execute.
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Curr Opin Anaesthesiol · Feb 2018
ReviewObstructive sleep apnea and bariatric surgical guidelines: summary and update.
Increasing numbers of bariatric surgical procedures and the high prevalence of obstructive sleep apnea (OSA) in this population have resulted in a growing interest in the perioperative management of OSA in bariatric surgery. This review provides a summary of the first consensus guideline on this topic as well as an update of the newest literature available. ⋯ Multiple precautions exist to minimize the risk of cardiopulmonary complications and to enhance recovery after surgery. A combination of these procedures seems to provide optimal perioperative care of OSA patients undergoing bariatric surgery. Nearly 75% of recommendations are based on low quality of evidence, indicating the high value of experts' opinion and potential for future research.
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This narrative review summarizes recent insights into the role of vitamin C in sepsis. ⋯ In-vitro evidence supports a critical role for vitamin C in cellular mechanisms relevant to the pathophysiology of sepsis. However, whether this justifies therapeutic use of vitamin C in septic patients remains uncertain.
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Curr Opin Anaesthesiol · Feb 2018
ReviewPostoperative thrombocytopenia: why you should consider antiplatelet therapy?
This review addresses the role of platelets in perioperative ischemic complications involving the brain, kidneys, and gastrointestinal tract, and long-term survival in patients undergoing coronary artery bypass grafting surgery. Importantly, findings of several recent clinical studies will be discussed with emphasis on platelet activation and leukocyte inflammatory responses as important mediators of vascular microthrombosis and ischemic injury. ⋯ For over 6 decades, major postoperative complications after cardiac surgery have remained unchanged. The potential influence of microthrombosis involving platelets has been underappreciated and use of perioperative antiplatelet therapy remains very limited - primarily because of a culture of fear of bleeding.
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Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. ⋯ Current recommendations for perioperative stress dose steroids for patients on chronic glucocorticoid therapy are based on duration and dose of maintenance steroids. All patients should take their regular daily dose of steroid preoperatively regardless of dose or chronicity of prior treatment. Additional, stress dose steroid dosing is based on patient risk of adrenal suppression and surgical complexity and stress.