Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2010
ReviewCerebral monitoring to optimize outcomes after cardiac surgery.
Although significant achievements have been made in the perioperative care of patients undergoing cardiac surgery, adverse cerebral outcomes remain an ongoing concern. Multiple approaches have been utilized to address neurologic complications, though definitive therapeutic strategies are lacking. This review focuses on the various cerebral monitoring options that can be used in cardiac surgery to improve perioperative outcomes. ⋯ The use of a comprehensive cerebral monitoring strategy can optimize cerebral outcomes after cardiac surgery.
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Heparin-induced thrombocytopenia (HIT) is an important, increasingly recognized antibody-mediated complication of heparin therapy occurring in approximately 0.5-5% of patients receiving heparin for at least 5 days. HIT is a prothrombotic disorder that typically presents with a 50% platelet count drop, thrombotic event manifesting usually 5-14 days after starting heparin, or both. HIT antibodies usually decrease to negative titers/levels within 3 months. When there is clinical suspicion of HIT, heparin should be discontinued and alternative anticoagulation should be considered, as well as laboratory evaluation for HIT. ⋯ For patients with HIT, alternative anticoagulation is available, but for cardiovascular surgery, if the operation cannot be delayed until HIT antibodies have become negative, alternative anticoagulation strategies are recommended, although patients with HIT are at a greater risk for adverse outcomes.
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Curr Opin Anaesthesiol · Dec 2009
ReviewAnaesthesia for the patient with dementia undergoing outpatient surgery.
Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery. ⋯ Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.
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Curr Opin Anaesthesiol · Dec 2009
ReviewEscort accompanying discharge after ambulatory surgery: a necessity or a luxury?
There is a growing demand for greater efficiency in ambulatory surgery. The patient population is increasingly sick which is also undergoing more advanced and complex surgery. This creates a danger in discharging patients without meeting the criterion of requirement of a responsible adult as an escort to accompany the patient home. The purpose of this review is to examine the most recent findings to determine whether an escort for patient discharge is necessary. ⋯ Both clinicians and patients may have underestimated the risks associated with discharging patients without an escort after ambulatory anesthesia. There should be greater awareness of this problem. Patient discharge without an escort after ambulatory surgery under general anesthesia, sedation or premedication can potentially be dangerous and is not recommended.