Best practice & research. Clinical anaesthesiology
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Anemia is associated with perioperative mortality and morbidity. Since the presence of anemia and blood transfusion often go hand in hand, it can be difficult to separate the effects of anemia from the effects of perioperative transfusion. The role for blood transfusion in mitigating the mortality and morbidity associated with anemia is unclear. ⋯ Further research is warranted in patients with the acute coronary syndrome, as there is insufficient evidence to make recommendations for this patient population. Additional multi-center randomized controlled trials need to be conducted in perioperative and critically ill patients with large enough sample sizes to examine differences in mortality and major complications between liberal and restrictive transfusion strategies. Further trials need to incorporate current practices in improved blood storage and leukoreduction techniques.
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Hemodynamic monitoring is the cornerstone of perioperative anesthetic monitoring. In the unconscious patient, hemodynamic monitoring not only provides information relating to cardiac output, volume status and ultimately tissue perfusion, but also indicates depth of anesthesia and adequacy of pain control. ⋯ No single device provides a complete assessment of hemodynamic status, and the use of all devices in every situation is neither practical nor appropriate. This article aims to provide the reader with an overview of the devices currently available, and the information they provide, to assist anesthesiologists in the selection of the most appropriate devices for any given situation.
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Best Pract Res Clin Anaesthesiol · Dec 2012
ReviewEffects of perioperative fasting on haemodynamics and intravascular volumes.
Maintaining cardiac preload throughout the perioperative period is a generally accepted target. As perioperative fasting is believed to cause intravascular hypovolaemia it traditionally triggers aggressive preemptive intravenous fluid infusion. Physiology suggests that extracellular losses via urinary output and evaporation decrease the extracellular compartment. ⋯ Nevertheless, an intravenous colloid challenge can increase stroke volume after induction of anaesthesia in the majority of surgical patients. While perioperative stroke volume maximisation in high-risk surgery probably improves outcome, the implication of this observation for the routine patient remains unclear. It appears as though there are two important targets to preserve cardiac preload: normovolaemia and vasotension.