Minerva anestesiologica
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Day surgery (DS) is continuously expanding due to both economic pressure and improvement in surgery and anesthesia. In the 1970s, only healthy patients undergoing simple procedures were accepted. Subsequent studies demonstrated that mortality and major morbidity are rare. ⋯ Patient clinical status is only one of the factors that should be considered. Surgeon's and anesthetist's skill, surgery and anesthesia technique and surgical setting are equally important. Therefore, only after evaluating their own experience and results are DS centers allowed to decide whether or not to treat a challenging patient as an outpatient.
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All volatile anesthetics have cardiac depressant effects that decrease myocardial oxygen demand and may thus improve the myocardial oxygen balance during ischemia. Recent experimental evidence has clearly demonstrated that, in addition to these indirect effects, volatile anesthetic agents also directly protect from ischemic myocardial damage. ⋯ Multicenter, randomized clinical trials previously demonstrated that desflurane could reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft surgery, either with or without cardiopulmonary bypass. However, evidence in non-coronary surgical settings is contradictory and will be reviewed in this paper, together with the mechanism of cardiac protection by volatile agents.
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This review describes the incidence, risk factors, and long-term consequences of cognitive dysfunction after cardiovascular surgery. Postoperative cognitive dysfunction (POCD) is increasingly being recognized as an important complication, especially in the elderly. A highly sensitive neuropsychological test battery must be used to detect POCD and a well-matched control group is very useful for the analysis and interpretation of the test ⋯ POCD seems to have important long-term consequences regarding self-assessed quality of life, survival, and labor market attachment.
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Postoperative residual curarization is still a problem of the modern anesthesia. Neostigmine is not the safest drug that allows a safe decurarization, especially when neuromuscular transmission monitoring is not used. Sugammadex is a A-cyclodextrin designed to encapsulate rocuronium bromide, providing a rapid reversal of neuromuscular blockade. ⋯ Volatile agents such as sevoflurane seems not to influence the sugammadex ability to reverse the rocuronium neuromuscular blockade. There is no difference in the sugammadex pharmacokinetic in children and adults. Sugammadex would be able to have a role in the future in reversing a non depolarizing steroidal neuromuscular block.
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Minerva anestesiologica · May 2009
ReviewInfluence of beta-blockers on the outcome of at risk patients.
Present recommendations for perioperative ss-blockade are solely based on the findings of two randomized controlled trials of inadequate methodology and data analysis in just a little over 300 patients performed in the late 1990s. The PeriOperative ISchemic Evaluation study is the first adequately powered controlled randomized trial on the efficacy and safety of perioperative ss-blocker therapy. ⋯ A recently published meta-analysis confirmed in large parts these findings. Based on these publications, most of the present recommendations for perioperative ss-blocker therapy are no longer supported by evidence and respective revision is needed.