Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2006
ReviewAnesthetic considerations in patients with previous thoracic surgery.
This review presents an overview of the different problems and challenges after thoracic surgery. It covers the pathophysiological changes that may occur regularly in the early and late period following surgery. In addition, surgical complications with anesthesiological implications for diagnosis, treatment and prevention are discussed, and consequences for anesthesia in further major and thoracic surgical procedures are shown. ⋯ Current literature presents no general recommendations on how to manage patients after recent thoracic surgery. Therefore it is necessary to find an individual strategy to handle possible complications and well known pathophysiological changes. Knowledge and understanding of the etiology, the pathophysiology and the risk factors of the perioperative period, allows prevention and target intervention aimed at reducing morbidity and mortality following surgery.
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Curr Opin Anaesthesiol · Feb 2006
ReviewNewer approaches to the pharmacological management of heart failure.
The treatment of acute heart failure is gaining importance, specifically in the perioperative setting. Increasing evidence shows that established forms of therapy using beta-adrenergic inotropic drugs have no effect on long-term survival; thus, anesthetists and intensive care specialists are focusing on new strategies. This review examines, with respect to the literature of the past year, whether these strategies will gain significance in the perioperative setting. ⋯ For perioperative treatment of acute heart failure, levosimendan, nesiritide and L-NAME constitute promising alternatives to conventional inotropic and vasodilatory drugs. The strongest evidence for improving outcome is given for levosimendan. According to the present literature, tezosentan does not currently have any significance for treatment of perioperative heart failure.
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During anesthesia and surgery oxygen is routinely administered to all patients. Inspired oxygen concentrations, however, vary between 30 and 100%, and oxygen is often administered in a seemingly random manner. During the last decade it has been shown in several randomized trials that perioperative supplemental oxygen administration might improve outcome after certain surgical procedures. The purpose of this review is to provide an overview about the benefits and risks of supplemental oxygen administration in the perioperative period. ⋯ Supplemental oxygen administration during the perioperative period might be a simple, inexpensive and well-tolerated treatment option to improve patient outcome. The optimal inspired oxygen concentration still needs to be evaluated.
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Hypoxemia is considered to be the most important challenge during one-lung ventilation. Recent studies, however, have shown that one-lung ventilation can involve some lung damage and can therefore be per se a cause of hypoxemia. ⋯ Hypoxemia should always be considered as the most important challenge during one-lung ventilation. One should also keep in mind, however, that some ventilatory strategies can even be harmful.