Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2022
ReviewInhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist?
Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. ⋯ Research findings regarding the use of volatile anesthetic versus TIVA for better outcomes after cardiac surgery are inconsistent. Variability in timing, duration, dosing, and type of VA as well as surgical and patient-related factors may have influenced these results. Therefore, either technique can reasonably be adopted depending on provider and institutional preference and used safely in patients undergoing cardiac surgery.
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Curr Opin Anaesthesiol · Feb 2022
ReviewCoronavirus disease 2019 and cardiovascular diseases: collateral damage?
Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is relatively common and portends an increased risk of morbidity and mortality. Manifestations of myocardial injury may exhibit significant overlap and result in diagnostic uncertainty. This review will summarize recent literature around cardiovascular complications of COVID-19. ⋯ Various forms of COVID-19-related myocardial injury have been associated with increased utilization of mechanical ventilation, hemodynamic deterioration, and mortality. Manifestations of myocardial injury in COVID-19 are varied, but share common drivers of illness including sequelae of sepsis, immune-mediated factors, and a prothrombotic state. Understanding the forms of myocardial injury in COVID-19 may aid in rapid diagnosis and treatment.
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Curr Opin Anaesthesiol · Feb 2022
ReviewPreoperative evaluation of geriatric patients undergoing liver transplantation.
As the population of the world is aging the number of geriatric patients undergoing liver transplantation (LT) is also increasing. They pose a unique challenge for the caregivers, as they have age-related physiological changes, multiple comorbidities and cirrhosis-related pathologies. ⋯ Proportion of elderly patients who are undergoing LT continues to increase. These patients require comprehensive cardiopulmonary and frailty evaluation. Consensus-based practice advisories need to be developed to standardize preoperative evaluation of geriatric patients awaiting LT.
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Anesthesia for pulmonological interventions is a demanding challenge. This article discusses recent innovations and the implications for periinterventional anesthetic management. ⋯ The development of new pulmonological methods requires a tailored anesthesiological approach. Their specific impact must be taken into account to ensure patient safety, goal-oriented outcome diagnostics and -quality, successful interventions, and patient comfort.