Current opinion in anaesthesiology
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Pregnancy exacerbates sickle cell disease (SCD) and is associated with increased frequency and severity of complications resulting in high levels of maternal and fetal morbidity and mortality. We review recent recommendations for managing SCD in pregnancy. ⋯ Patients should be managed by a multidisciplinary and experienced team. The perioperative episode is a recognized period of disease exacerbation and informed anesthetic management can contribute to improved patient outcomes.
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Curr Opin Anaesthesiol · Jun 2021
ReviewThe disruptive physician and impact on the culture of safety.
The disruptive physician is a growing problem in medicine. All too often, physician behavior negatively impacts the delivery of quality patient care. The hostile environment that certain behaviors create makes it difficult for team members advocate for their patients. It is imperative that physician practices develop and an understanding of how to identify the disruptive physician to maintain patient safety. ⋯ The practice of medicine is multifaceted. It is imperative that the assurance of psychological safety is met to meet the standards of high quality and safe care for patients.
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Curr Opin Anaesthesiol · Jun 2021
ReviewHow new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury.
Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evidence and explain why timely perioperative management does have impact on the development of AKI and overall outcomes for patients. ⋯ AKI is a time critical syndrome that requires timely detection and damage biomarkers can help to adjust the perioperative management to prevent further injury.
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An increasing number of patients with endocrine disorders will present to the operating rooms. In this review, we outline the common endocrine disorders that the anesthesiologist may face in the perioperative time span, review the controversies in optimal management, as well as summarize the recent literature for the management of these complex patients. ⋯ Endocrine disorders will commonly present in the perioperative time period and the anesthesiologist plays a critical role in achieving good operative outcomes.
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Curr Opin Anaesthesiol · Jun 2021
ReviewPerioperative risk assessment - focus on functional capacity.
This review examines how functional capacity informs preoperative risk stratification, as well as strengths and limitations of options for estimating functional capacity. ⋯ A straightforward way to better assess functional capacity is a structured interview with validated questionnaires or standardized questions about physical activities. Functional capacity can also be assessed by exercise tests, with the strongest evidence supporting CPET. Although some simpler exercise tests have shown promise, more research remains needed to better define their role in preoperative evaluation.