Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2009
ReviewTattooing and various piercing: anaesthetic considerations.
Body art is increasing since the 1990s. Anaesthesiologists would be more and more confronted to patient with tattooing or piercing, or both. This review discusses the anaesthetic potential risks and complications observed with tattooing and piercing, their management and prevention. ⋯ Oral and nasal piercing is of particular concern because of the risks of swallowing and aspiration. Consequently, patients should be advised to remove piercing before anaesthesia. Emergency situations are especially risky and anaesthesiologists should be aware of the piercing removal techniques. In case of piercing loss, radiographies and fiberoptic endoscopy of the upper airways and digestive tracts should be performed to eliminate aspiration or swallowing of the foreign body. Epidurals should not be denied to parturients with lumbar tattooing. However, it seems still prudent to avoid direct tattoo puncture or when unavoidable, to nick the skin prior to inserting the needle through the tattoo.
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Curr Opin Anaesthesiol · Apr 2009
ReviewApplying gases for microcirculatory and cellular oxygenation in sepsis: effects of nitric oxide, carbon monoxide, and hydrogen sulfide.
Nitric oxide, carbon monoxide, and hydrogen sulfide (H2S) are gases that have received attention as signaling molecules regulating many biological processes. All of them were reported to have beneficial effects in inflammatory states, in particular for microcirculatory perfusion and tissue energy balance. Thus, this review will highlight the most important results with a focus on resuscitated, clinically relevant experimental models and, if available, human studies. ⋯ It is still a matter of debate whether manipulating nitric oxide, carbon monoxide, or H2S tissue concentrations, either by using the inhaled gas itself or by administering donor molecules or inhibitors of their endogenous production, is a useful therapeutic approach to improve microcirculatory blood flow, tissue oxygenation, and cellular respiration. This is mainly due to their 'friend and foe character' documented in various experimental models, but also to the paucity of data from long-term, resuscitated large animal experiments that fulfil the criteria of clinically relevant models.
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Curr Opin Anaesthesiol · Apr 2009
ReviewTransfusion in trauma: why and how should we change our current practice?
Major trauma is often associated with hemorrhage and transfusion of blood and blood products, which are all associated with adverse clinical outcome. The aim of this review is to emphasize why bleeding and coagulation has to be monitored closely in trauma patients and to discuss the rationale behind modern and future transfusion strategies. ⋯ Future transfusion strategies are based on early and continuous assessment of the bleeding and coagulation status of trauma patients. This allows specific and goal-directed treatment, thereby optimizing the patient's coagulation status early, minimizing the patient's exposure to blood products, reducing costs and improving the patient's outcome.
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Curr Opin Anaesthesiol · Apr 2009
ReviewMicrocirculatory effects of intravenous fluids in critical illness: plasma expansion beyond crystalloids and colloids.
Plasma expanders are reviewed to determine their ability to restore microvascular function as a means for extending the transfusion trigger and delaying the use of blood transfusions. This outcome is currently achievable because of the emergence of a new understanding of optimal tissue function that prioritizes maintenance of functional capillary density, which results from the normalization of blood viscosity via the increase in plasma viscosity with new viscogenic colloids. ⋯ Preclinical studies show that polyethylene glycol-conjugated albumin at concentrations in the range of 2-4% extends the transfusion trigger, providing the more extended and complete microvascular and systemic recovery from hemorrhagic shock, extreme hemodilution and endotoxemia, postponing the need of reestablish intrinsic blood oxygen-carrying capacity to hemoglobin concentrations lower than those associated with accepted transfusion triggers.
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Curr Opin Anaesthesiol · Apr 2009
ReviewCoagulopathy in trauma patients: what are the main influence factors?
Coagulopathy and bleeding after severe injury is a common problem. Whenever caring for critically ill patients, clinicians must anticipate, recognize and manage the coagulopathy of trauma. When left untreated, cardiovascular shock and multiorgan system failure ensue. Uncompensated hemorrhage often culminates in death, highlighting the significance of recognizing the main influences in coagulopathy of trauma. ⋯ Although mortality previously was thought to be summarily independent of medical interventions and resuscitations, we now know the opposite to be true; it is our expectation and indeed our obligation to recognize and manage the coagulopathy of trauma better than in past years. In as much as we continue to prevent acidosis, hypothermia and the progressive coagulopathy following injury, trauma victims the world over are benefiting and surviving longer, living proof that demonstrates the utility of managing the coagulopathy of trauma.