Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2008
ReviewThe toxicity of local anesthetics: the place of ropivacaine and levobupivacaine.
Ropivacaine and levobupivacaine were developed after evidence of bupivacaine-related severe toxicity. Despite a comparable analgesic profile, quantitative differences become evident with regard to their specific rate of systemic toxicity. The present article provides a concise review of the toxic potencies of levobupivacaine and ropivacaine. ⋯ Compared with bupivacaine, both agents may be considered as 'more well tolerated' but not as 'totally well tolerated', as they are still capable of inducing systemic and local toxicity. However, ropivacaine seems to have the greatest margin of safety of all long-acting local anesthetics at present.
-
To outline recent developments emphasizing the current literature on ophthalmic regional anaesthesia including modern sharp needle and blunt cannula sub-Tenon's blocks. ⋯ At present, there is no absolutely safe ophthalmic regional block. It is imperative therefore to have a basic knowledge of anatomy and technique which reduce complications.
-
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.
-
Curr Opin Anaesthesiol · Aug 2008
ReviewPerioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery.
Pulmonary hypertension is a condition that has a multitude of causes. Left untreated, patients with pulmonary hypertension will experience progressive symptoms of dyspnea and right heart failure resulting in significant morbidity and mortality. This review details the many evolving aspects of understanding related to pulmonary hypertension including signs and symptoms, pathophysiology, classification, anesthetic management including perioperative considerations and treatment options. ⋯ Coupled with aggressive use of improved diagnostic hemodynamic monitors perioperatively, these patients can be medically optimized during their hospitalization and possibly aid in improving their long-term prognosis.