Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2014
ReviewAnesthesia in neurologic and psychiatric diseases: is there a 'best anesthesia' for certain diseases?
Patients with diseases affecting the central nervous system present a wide range of clinical manifestations increasing the perioperative risk. The following review focused on recommendations for anaesthesiological management in patients with both neurologic and psychiatric diseases. ⋯ The 'best' anesthesia includes adequate preoperative evaluation of the individual risk, optimization of comorbidities before elective surgery, the use of short-acting anesthetic agents for induction and maintenance of general anesthesia, avoidance of volatile agents and succinylcholine in muscular dystrophy and myopathies.
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In the last decade, there has been a rapid development in new endovascular treatment options for cerebral aneurysms. These techniques have their own inherent risk and can be challenging for the attending anesthetist. ⋯ The different endovascular techniques relevant to the anesthetist, the anesthetic options and complications that can occur during endovascular treatment of these patients will be discussed. This article can be a guidance to the anesthesiologist attending endovascular procedures for cerebral aneurysms.
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Curr Opin Anaesthesiol · Aug 2014
ReviewScheduling for anesthesia at geographic locations remote from the operating room.
Providing general anesthesia at locations away from the operating room, called remote locations, poses many medical and scheduling challenges. This review discusses how to schedule procedures at remote locations to maximize anesthesia productivity (see Video, Supplemental Digital Content 1). ⋯ Remote locations with sufficient hours of cases should be allocated time reserved especially for them in which to schedule their cases, with a maximum waiting time of 2 weeks, to achieve an average wait of 1 week.
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Curr Opin Anaesthesiol · Aug 2014
ReviewManagement of right ventricular dysfunction in the perioperative setting.
This review summarizes the approach to and recent developments in the treatment of acute right ventricular dysfunction and failure in the perioperative setting. Right ventricular failure, defined as the inability to deliver sufficient blood flow through the pulmonary circulation at normal central venous pressure, is a common problem in the perioperative setting and is associated with an increased mortality. The failure of the right ventricle is caused by reduced right ventricular contractility or an increased right ventricular afterload or both. ⋯ Right ventricular dysfunction may cause venous congestion and systemic hypoperfusion. After identifying right ventricular dysfunction, the primary goal is to correct reversible causes of excessive load or reduced right-ventricular contractility. If the underlying abnormalities cannot be reversed, diuretic, vasodilator, or inotropic therapy may be required.