Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2023
ReviewCardiac surgery, ICU sedation, and delirium: is dexmedetomidine the silver bullet.
Delirium is a marker of acute brain insufficiency and a harbinger of poor outcomes and increased healthcare costs. Despite success preventing delirium by nonpharmacologic measures, the incidence in the postcardiac surgical ICU population remains high. Dexmedetomidine, a selective alpha-2 agonist, is a plausible preventive agent with sedative, anxiolytic, analgesic, sympatholytic and anti-inflammatory properties, and is the subject of very active study in cardiac surgery populations. ⋯ Although using dexmedetomidine to prevent delirium in unselected cardiac surgical patients is not supported by current evidence, there remains hope that it may offer benefits in highly selected populations, and further trials are ongoing.
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Curr Opin Anaesthesiol · Feb 2023
ReviewMultimodal prehabilitation program valuation for thoracic surgical patients.
Modifiable patient-related risk factors, such as physical, emotional, and cognitive frailty, poor nutritional status, sleep hygiene, anemia, alcohol abuse, and smoking reduce a patient's ability to effectively recover from the insult of surgery. Herein, we review the value of implementing a comprehensive prehabilitation program for patients undergoing thoracic surgery. ⋯ It stands to reason that well designed prehabilitation programs can add value by improving quality metrics at a lower cost to our healthcare system. Definitive randomized trials are needed to confirm this notion.
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Curr Opin Anaesthesiol · Feb 2023
ReviewMitochondrial transplantation in cardiac surgical patients: optimism, caveats, and outstanding questions.
Mitochondria satisfy the high metabolic demand of the heart, and also play major roles in reactive oxygen species signaling, calcium buffering, and regulation of cell death. Mitochondrial damage or dysfunction can drive diseases seen in cardiac surgical patients, including heart failure and ischemia/reperfusion injury. Exogenous transplantation of isolated mitochondria has been proposed as one way to augment mitochondrial function and mitigate a number of pathologic processes, with a heavy focus on ischemia/reperfusion injury. ⋯ Mitochondrial transplantation is a potential therapeutic strategy for cardiac ischemia/reperfusion injury. Effective application to selected cardiac surgical patients can be informed by further mechanistic investigations.
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Curr Opin Anaesthesiol · Feb 2023
ReviewImplementing change in the care of the complex cardiac patient.
Development of advanced and minimally invasive surgical procedures is providing treatment opportunities to older and higher risk patients. This has also led to highly specialized physicians and a need for better communication and planning with the patients and within the care team. ⋯ In this review, we discuss the concepts of shared decision making (SDM) and implementation science in the context of the complex cardiac patient. We also review the most recent evidence for their use in cardiac surgery. We argue that a team model not only bridges knowledge gaps but provides a multidisciplinary environment for the practice of SDM and implementation of evidence-based practices. Be believe this will provide patients with a better experience as they navigate their care and improve their medical outcomes as well.
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Curr Opin Anaesthesiol · Feb 2023
ReviewHow, when and why to establish preoperative surgical risk in thoracic surgery.
Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of comorbidities that may complicate thoracic procedures, and references recent best practices for their management. ⋯ Optimizing patients for thoracic surgery can be challenging for small and large health systems alike. Implementation of evidence-based guidelines can improve care and mitigate risk. As surgical techniques evolve, future research is needed to ensure that perioperative care continues to progress.