Current opinion in anaesthesiology
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This review presents the current available data to date regarding the perioperative risks associated with fluid management in thoracic surgery and its implications on the development of acute lung injury (ALI) as well as acute kidney injury (AKI). ⋯ Alternative fluid regimens to the traditional restrictive protocols used during thoracic surgery are being explored. These include normovolemic and goal-directed therapy protocols and the use of newer colloid solutions.
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To discuss the innovations in general thoracic surgery and how they affect anesthetic management perioperatively. However, rather than listing various thoracic procedures and their inherent issues that complicate providing anesthesia, the approach of this article is to raise the anesthetic issues associated with innovations in thoracic surgery perceived to be important by the thoracic surgeon. ⋯ Innovations in thoracic surgery continually emerge and challenge thoracic surgeons and anesthesiologists to evaluate their utility and benefits. The increased adoption of minimally invasive operations is a testament to this collaboration. This process requires an ongoing dialog between the clinicians within these two disciplines to advance the science of surgery.
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Curr Opin Anaesthesiol · Feb 2013
ReviewPerioperative coagulation management in the intensive care unit.
Coagulopathy in an ICU setting is multifactorial, but newer anticoagulation agents are the potentially contributing causes. Critically ill patients may suffer from disorders because of surgery or trauma, in addition to acquired causes including antiplatelet agents and the new oral anticoagulants. An understanding of the coagulopathy, hemostatic considerations, and therapeutic approaches is important when managing these patients. ⋯ Coagulopathy occurs in ICU patients because of multiple factors including anticoagulants, dilution, fibrinolysis, and factor consumption. Therapeutic prohemostatic pharmacologic approaches, in addition to standard transfusion therapy, need to be considered in managing coagulopathy in the ICU setting.
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Curr Opin Anaesthesiol · Feb 2013
ReviewAnesthetic considerations for interventional pulmonary procedures.
To discuss the anesthetic considerations of various procedures now performed by the interventional pulmonologist. With recent technological advances, many of these procedures represent acceptable alternatives to the invasive surgical procedures. For example, the placement of endobronchial valves can substitute for lung reduction surgery and can greatly reduce the postoperative recovery period. However, many of these complex procedures require anesthesia services. The nature and indication for the procedure as well as the patient's overall health will have an impact on the anesthetic choice. ⋯ As the array of diagnostic and therapeutic pulmonary interventions is expanding, the types of anesthetic techniques and ventilatory modes are varying to fit the procedural requirements. Some pulmonary procedures are best accomplished in the lightly sedated patient, who is breathing spontaneously, whereas procedures that use the working channel of a rigid bronchoscope are better performed in the patient under general anesthesia and mechanical ventilation that often use jet ventilation to minimize respiratory movements.