Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2008
ReviewUsing ventilation-induced plethysmographic variations to optimize patient fluid status.
Hypovolemia is one of the most frequent causes of arterial hypotension in the operating room. Pulse oximeter plethysmographic waveform, obtained using a noninvasive and widely available device, has recently shown its potential interest in predicting fluid responsiveness in mechanically ventilated patients under mechanical ventilation. This review highlights new applications of this routine monitoring. ⋯ Automatic detection of respiratory variations in pulse oximetry plethysmographic waveform amplitude can predict fluid responsiveness in the operating room in patients under mechanical ventilation and has potential for fluid optimization in this setting.
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Elimination of flammable anesthetic gases has had little effect on operating-room fires except to change their etiology. Electrocautery and lasers, in an oxygen-enriched environment, can ignite even the most fire-resistant materials, including the patient, and the fire triad possibilities in the operating room are nearly limitless. This review will: identify operating room contents capable of acting as ignition/oxidizer/fuel sources, highlight operating room items that are uniquely potent fire triad contributors, and operating room identify settings where fire risk is enhanced by proximity of triad components in time or space. ⋯ Operating room fires are infrequent but catastrophic. Operating room fire prevention depends on: (a)understanding how fire triad elements interact to create a fire, (b) recognizing how standard operating-room equipment, materials, and supplemental oxygen can become one of those elements, and (c) vigilance for circumstances that bring fire triad elements into close proximity.
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Curr Opin Anaesthesiol · Dec 2008
ReviewPulse oximetry and photoplethysmographic waveform analysis of the esophagus and bowel.
This article reviews the development of novel reflectance pulse oximetry sensors for the esophagus and bowel, and presents some of the techniques used to analyze the waveforms acquired with such devices. ⋯ The use of novel reflectance pulse oximetry sensors has been successfully demonstrated. Such sensors, combined with the application of more advanced signal processing, will hopefully open new avenues of research leading to the development of new types of pulse oximetry-based monitoring techniques.
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The purview of ambulatory anesthesia continues to broaden in response to national interest in controlling healthcare costs and eliminating unnecessarily expensive hospital stays. Recent advances in anesthesia allow us to minimize side effects and complications of anesthesia and surgery that might otherwise delay recovery and discharge. The purpose of this review is to highlight some of these latest advances in clinical care that may soon change how we practice. ⋯ The research and advances in clinical care described will likely influence how we manage our patients in the future, eliminating the need for prolonged hospital stay after surgery.
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Curr Opin Anaesthesiol · Dec 2008
ReviewReview of video laryngoscopy and rigid fiberoptic laryngoscopy.
Recent advances in fiberoptic systems and video technology have resulted in the development of new intubation devices and techniques. A defining characteristic of rigid fiberoptic and videolaryngoscopic techniques is that glottic opening is viewed indirectly in place of direct line-of-sight. Various issues common to all instruments in this group are highlighted, and a few recently released tools are described. The aim of this article is to review material published since January 2007. ⋯ As indirect laryngoscopic tools become more available, and clinicians become more facile in their use, the management of (potentially) difficult intubations is likely to change. Further technological advances are likely to lead to the development of even more new instruments.