Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2020
ReviewFascial plane blocks in thoracic surgery: a new era or plain painful?
The demand for well-tolerated, effective, and opioid reducing pain management has become imperative in thoracic surgery. With the recent movement away from neuraxial analgesia for thoracic surgical patients, great interest in alternative analgesic techniques of the chest wall has developed. Multiple fascial plane blocks have been developed for pain management of the lateral chest wall and we present an up-to-date review of these popular new interventions. ⋯ Fascial plane blocks hold the potential for well-tolerated and effective analgesia for thoracic surgical patients as part of a multimodal regimen of pain relief. However, many questions remain regarding block characteristics. As the literature matures, more formal recommendations will be made but quality trials are needed to provide this guidance.
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Curr Opin Anaesthesiol · Feb 2020
ReviewEffect of left ventricular diastolic dysfunction on development of primary graft dysfunction after lung transplant.
Primary graft dysfunction (PGD) is one of the most common complications after lung transplant and is associated with significant early and late morbidity and mortality. The cause of primary graft dysfunction is often multifactorial involving patient, donor, and operational factors. Diastolic dysfunction is increasingly recognized as an important risk factor for development of PGD after lung transplant and here we examine recent evidence on the topic. ⋯ Patients with diastolic dysfunction is more likely to suffer from PGD after lung transplant. From the lung transplant candidate selection to perioperative and posttransplant care, thorough evaluation and documentation diastolic dysfunction to guide patient care are imperative.
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Curr Opin Anaesthesiol · Feb 2020
ReviewAntibiotic dosing during extracorporeal membrane oxygenation: does the system matter?
The aims of this review are to discuss the impact of extracorporeal membrane oxygenation (ECMO) on antibiotic pharmacokinetics and how this phenomenon may influence antibiotic dosing requirements in critically ill adult ECMO patients. ⋯ An advanced understanding of the pharmacokinetic alterations in critically ill patients receiving ECMO is essential to provide optimal antibiotic dosing in these complex patients pending robust dosing guidelines. Antibiotic dosing in this patient population should generally align with the recommended dosing strategies for critically ill patients not on ECMO support. Performing therapeutic drug monitoring (TDM) to guide antibiotic dosing in this patient population appears useful.
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Curr Opin Anaesthesiol · Feb 2020
ReviewImpact of geriatric co-management programmes on outcomes in older surgical patients: update of recent evidence.
To determine the impact of geriatric co-management programmes on outcomes in older patients undergoing a surgical procedure. ⋯ There was a shorter length of stay, less mortality and a lower readmission rate. However, there was uncertainty whether the results are clinically relevant and the GRADE of evidence was low. It was uncertain whether the outcomes time to surgery and complications were improved. The evidence is limited to hip fracture patients.
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Lung transplantation can be performed off-pump, with sequential one-lung ventilation, or using mechanical circulatory support (MCS). MCS can either be in the form of cardiopulmonary bypass (CPB) or veno-arterial or veno-venous extracorporeal membrane oxygenation (VA ECMO or VV ECMO).This article reviews the indications, benefits and limitations of these different techniques and evaluates their effect on outcomes. ⋯ The trend toward ECMO and away from cardiopulmonary bypass is backed up with good survival rates. However, to date, there has not been a randomized controlled trial to further guide the choice of MCS strategy for lung transplantation.