Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2007
ReviewNon-antiarrhythmic agents for prevention of postoperative atrial fibrillation: role of statins.
Atrial fibrillation is the most common arrhythmia following cardiac surgery, having both serious medical and socioeconomic consequences. Although there are established antiarrhythmic agents for preventing and treating postoperative atrial fibrillation, these therapies are neither 100% reliable, nor without risks and limitations. Thus, there remains a strong need for non-antiarrhythmic, adjunctive therapies for the prevention of postoperative atrial fibrillation. ⋯ Perioperative statin therapy may represent an important non-antiarrhythmic, adjunctive therapeutic strategy for the prevention of postoperative atrial fibrillation.
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Curr Opin Anaesthesiol · Feb 2007
EditorialManagement of the patient with a large anterior mediastinal mass: recurring myths.
This editorial review summarizes the current anesthetic management of patients with anterior mediastinal masses. ⋯ General anesthesia is not safe in patients with severe positional symptoms from an anterior mediastinal mass. With modern imaging techniques, general anesthesia is rarely needed for diagnostic procedures in these patients. Preoperative flow-volume loops are not useful in the management of these patients and the concept of cardiopulmonary bypass on 'standby' is not appropriate during induction of anesthesia.
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Echocardiography has been used perioperatively as an important diagnostic tool since the 1980s. Introduction of this new technique has been beneficial to our practice, but has also introduced questions and issues related to methods of teaching, requirements for demonstration of competence and testing and certification processes as evidence of satisfactory completion of necessary learning parameters. This article will review the issues presented to date, how they have been addressed, and what options could be arriving in the future. ⋯ Perioperative echocardiography has rapidly become an integral part of anesthetic practice. The training and certification process has been formalized. There are still issues related to difficulty of training individuals outside core residency programs.
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Curr Opin Anaesthesiol · Dec 2006
ReviewUltrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques.
This article introduces the use of ultrasound to facilitate peripheral regional anesthesia. ⋯ Ultrasound technology represents an ideal mechanism by which the regional anesthesiologist can attain the safety, speed, and efficacy of general anesthesia. Ultimately, it is the correct peri-neural spread of local anesthetic around a nerve that provides safe, effective, and efficient anesthetic conditions.
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Curr Opin Anaesthesiol · Dec 2006
ReviewWhich muscle relaxants should be used in day surgery and when.
After myorelaxants, myalgia and residual curarization may complicate recovery. Local anaesthesia and minimally invasive airway management make myorelaxants disputable in many outpatient procedures; nevertheless, neuromuscular blockade may be necessary to facilitate intubation or maintain muscle relaxation. Agent selection criteria are discussed. ⋯ Ear-nose-throat, open eye surgery and laparoscopy may demand myoresolution. Regional and minimally invasive anaesthesia are alternative solutions. Central and peripheral nerve blocks are associated with increased induction time, reduced pain scores, and decreased need for analgesics. Central neuraxial block, however, is associated with prolonged outpatient unit stay. Bad intubating conditions may cause pharyngo-laryngeal complications: the decision to avoid myorelaxants for tracheal intubation appears illogical. Incidence of postoperative residual curarization remains very high. Sugammadex offers new perspectives.