Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewIncreased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery.
Literature since 2006 was reviewed to identify the harms and costs of red blood cell (RBC) transfusion. ⋯ The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services. This evidence should shift clinicians' equipoise towards more restrictive transfusion practice. The immediate aim should be to avoid transfusing small numbers of RBC units for general malaise attributed to anaemia, a practice which appears to occur in about 50% of transfused patients. Randomized trials comparing restrictive and liberal transfusion triggers are urgently needed to compare directly the balance of benefits and harms from RBC transfusion.
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Curr Opin Anaesthesiol · Oct 2008
ReviewTranscranial Doppler ultrasonography: a diagnostic tool of increasing utility.
Since its introduction in 1982, transcranial Doppler ultrasonography has become an important diagnostic and monitoring tool in patients with surgical disease. It has applications in the perioperative period, as well as in the intensive care unit. It is therefore appropriate for the anesthesiologist to maintain an understanding of its current utility. ⋯ Although there are several settings in which transcranial Doppler has well established usefulness, there are many more in which it is likely valuable, such as traumatic brain injury, ischemic stroke, and fulminant hepatic failure. Further research is needed in these fields to elucidate the exact role for transcranial Doppler.
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To discuss closed-loop systems, the engineering behind them, and the application of these systems. ⋯ The future anesthesiologist may devote less time to easily delegated tasks when in the operating room. The ability of computers to maintain variables in a set range allows some tasks to be automated. Although monitoring of these systems will never be completely eliminated, the necessity for minute-to-minute intervention may.