Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2011
ReviewRegional anesthetic procedures in immunosuppressed patients: risk of infection.
Due to demographic developments anesthesiologists encounter an increasing number of older and multimorbid patients in their daily routine. Consequently the proportion of immunosuppressed patients (e.g. those with cancer, diabetes mellitus, and those receiving immunosuppressive treatment and/or chemotherapy - e.g. for inflammatory bowel diseases, autoimmune diseases, and after transplantation) will also rise. Regional anesthesia (peripheral nerve blocks and neuraxial blockade) may be beneficial in these patients and will have to be considered in order to provide adequate pain management and minimize risks for the patients. ⋯ So far, there are no guidelines available dealing with indications and limitations of regional anesthetic procedures in these patients. The complication rate is rare but potentially disastrous. However, the technique itself cannot be regarded as absolute contraindication for immunosuppressed patients if precautions are taken. An interdisciplinary approach regarding the indication of regional anesthesia techniques in immunosuppressed patients is recommended. Efforts must therefore be made to achieve an interdisciplinary consensus with relevant risk-benefit considerations.
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Curr Opin Anaesthesiol · Dec 2011
ReviewThe potential benefits and the role of cerebral monitoring in carotid endarterectomy.
The benefit of carotid endarterectomy (CEA) in patients with symptomatic severe carotid stenosis is highly dependent on the perioperative stroke rate. Cerebral monitoring plays an important role in reducing the perioperative stroke rate as it allows detection of the main causes of perioperative stroke, being embolism, intraoperative hypoperfusion and postoperative hyperperfusion syndrome. However, some physicians doubt about the benefit of cerebral monitoring and consider it costly and time consuming. The aim of this review is to provide an overview of the available cerebral monitoring modalities and their role in CEA. ⋯ In our opinion, cerebral monitoring during CEA is essential because it provides direct information regarding new neurological deficits, which might otherwise be missed. Intraoperative cerebral monitoring provides immediate feedback to the treating physician allowing prompt correction in tissue handling. Several monitoring modalities are available for cerebral monitoring in CEA, but no single test is comprehensive. Therefore, a combination of several monitoring modalities with each specific strength not only during but also after CEA is recommended to cover all needs and reduce the perioperative stroke rate.
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This review intends to give an overview of developments in anaesthesia residency training. ⋯ Innovations in the field of educational studies have provided us with tools to improve the training of our residents. Portfolio, simulation and quality assurance are among the most prominent developments aimed at creating successful residency programmes. Financial implications of the implementation of educational innovations should, however, be considered.
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Curr Opin Anaesthesiol · Dec 2011
ReviewConsiderations for patients with obstructive sleep apnea undergoing ambulatory surgery.
The purpose of this article is to discuss the anesthetic considerations of obstructive sleep apnea (OSA) patients undergoing ambulatory surgery and the current recommendations based on recent evidence. ⋯ The recent publications indicated that the majority of OSA patients may be done as ambulatory surgical patients with few adverse events. However, it may not be safe to do patients with severe OSA requiring postoperative narcotics as ambulatory surgical patients.
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We critically review brain function monitors based on the processed electroencephalogram with regards to signal quality, artefacts and other limitations in clinical performance. ⋯ Clinicians should be aware of the several limitations of the commercial devices intending to monitor the depth of anaesthesia, which may not reflect the real underlying level of unconsciousness.