Current opinion in anaesthesiology
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This review aims to surmise a bioethical approach to the phenomenon of cancelling patient operations. There is increasing public and political interest in the matter with a rise in the frequency of cancellations. Cancellations are emotional for patients and are difficult clinical decisions. ⋯ Although cancellations are undesirable, they are inevitable and form part of the duties of a doctor. When they do occur, care must remain patient-centred, asking how we can improve this situation.
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Curr Opin Anaesthesiol · Apr 2020
ReviewPediatric non-red cell blood product transfusion practices: what's the evidence to guide transfusion of the 'yellow' blood products?
Research studies pertaining to the management of pediatric non-red cell blood product transfusion is limited. Clinical practices vary within disciplines and regions. Anesthesiologists need evidence-based guidelines to make appropriate and safe decisions regarding transfusion of the 'yellow' blood products for pediatric patients. ⋯ Evidence-based guidelines and expert consensus recommendations exist to guide the transfusion of pediatric non-red blood products and should be followed when transfusing the 'yellow' blood components. As high-quality studies in neonates, infants and children are limited, future research should broaden our knowledge in this direction with the goal to use restrictive strategies to improve patient outcomes.
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Curr Opin Anaesthesiol · Apr 2020
ReviewInflammatory response in trauma patients: are there ways to decrease the inflammatory reaction?
Trauma patients are considered a complex population of patients in emergency medicine and need extensive, specialized therapy. One major part is the prevention and treatment of the inflammatory response, which occurs in patients after severe injury resulting in complications like endotheliopathy. Likely as a consequence, coagulopathy occurs. Sterile inflammation is hard to address, especially because of the lack of a single activator. Moreover, it is a complex composition of factors that lead to a pathologic immune response. Our understanding of these patterns is increasing, but the complete pathophysiologic changes have yet to be investigated. Therefore, there is no specific target to treat inflammatory response in trauma patients at the moment. ⋯ Our increasing understanding of the immune system have led to new potential therapeutic perspectives. All of these approaches need further research to be validated. As the current therapies are based on empirical strategies and have not changed much over the years, new treatment options would be an important progress.
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Communication and teamwork are essential to enhance the quality of care, especially in operating rooms and ICUs. In these settings, the effective interprofessional collaboration between surgeons and intensivists impacts patients' outcome. This review discusses current opinions and evidence for improving communication strategies and the relationship between surgeons and intensivists/anesthesiologist. ⋯ Although limited, current evidence suggests to improve communication and teamwork in patient perioperative care. Further research is needed to strengthen the surgeon-intensivist relationship and to deliver high-quality patient care.