Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2013
ReviewDo corticosteroids improve outcome for any critical illness?
Corticosteroids have been widely administered in critically ill patients for various indications. Their clinical benefit is broadly investigated but remains controversial. The purpose of this review is to explore the use of corticosteroids in intensive care, their impact on patient outcome and to provide practical guidance for the use of corticosteroids in the ICU. ⋯ Critical illnesses stem from a group of heterogeneous medical conditions. Failure to target subgroups more likely to benefit from the use of corticosteroids may be one explanation for the largely disappointing results in clinical trials, thus, far.
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Curr Opin Anaesthesiol · Apr 2013
ReviewInformed consent for special procedures: electroconvulsive therapy and psychosurgery.
Informed consent has become the cornerstone of the expression of patient's autonomy for ethical and sound patient-physician relationships. However, some severe psychiatric diseases markedly hinder the ability of selected patients to ensure a proper consent. Confronted with mentally disabled individuals whose condition may lead to violence or inflicting it on others, society must carry out its duty of protecting those who are particularly vulnerable, while respecting and protecting these disabled individuals. ⋯ Consent can be relatively easy to secure in selected patients who are often fully aware of their torments (such as those suffering from severe refractory depression of obsessive-compulsive disorders) whose suffering may be such that they are ready to accept, or for that matter demand, such actions. However, the duty of physicians is to realize that pains should always be taken to do as much good (and as little harm) as possible, while respecting the freedom of decision of those who seek to help.
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Curr Opin Anaesthesiol · Apr 2013
ReviewWhy are we doing this case? Can perioperative futile care be defined?
The present review addresses the question of whether perioperative futility can be defined. ⋯ The present review will provide anesthesiologists with critical insight into the historical scholarship and current recommended process to address questions of perioperative futility.
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To evaluate new information on the importance of right ventricular function, diagnosis and management in cardiac surgical patients. ⋯ The use of right ventricular pressure monitoring and the publications of guidelines for the echocardiographic assessment of right ventricular anatomy and function allow the early identification of right ventricular failure. The treatment success will be associated by optimization of the hemodynamic, echocardiographic and near-infrared spectroscopy parameters.