Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewGeneral anesthetic techniques for enhanced recovery after surgery: Current controversies.
General anesthesia technique can influence not only immediate postoperative outcomes, but also long-term outcomes beyond hospital stay (e.g., readmission after discharge from hospital). There is lack of evidence regarding superiority of total intravenous anesthesia over inhalation anesthesia with regards to postoperative outcomes even in high-risk population including cancer patients. ⋯ Given that the residual effects of drugs used during anesthesia can increase postoperative morbidity and delay recovery, it is prudent to use a minimal number of drug combinations, and the drugs used are shorter-acting and administered at the lowest possible dose. It is imperative that the discerning anesthesiologist consider whether each drug used is really necessary for accomplishing perioperative goals.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewEnhanced recovery after surgery: Current status and future progress.
Enhanced Recovery After Surgery (ERAS) pathways were first introduced almost a quarter of a century ago and represent a paradigm shift in perioperative care that reduced postoperative complications and hospital length of stay, improved postoperative quality of life, and reduced overall healthcare costs. Gradual recognition of the generalizability of the interventions and transferable improvements in postoperative outcomes, led them to become standard of care for several surgical procedures. In this article, we critically review the current status of ERAS pathways, address related controversies, and propose measures for future progress.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPrehabilitation before surgery: Is it for all patients?
To evaluate the role of prehabilitation interventions in adult patients before elective major surgery. ⋯ Studies evaluating multimodal prehabilitation interventions before elective major surgery in adults are producing encouraging early results, but definitive clinical effectiveness is currently very limited. Future research should focus on refining interventions, exploring mechanisms, establishing minimum dosage, interrogating interactions between therapies, and urgent implementation of large-scale clinical effectiveness studies.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewPrinciples for minimizing oxygen debt: can they translate to clinical application and improve outcomes?
Oxygen delivery is dependent on pulmonary gas exchange, cardiac output, blood oxygen-carrying capacity, and tissue oxygen extraction. Reduction in oxygen delivery or higher oxygen consumption can initiate complex protective cellular processes precipitating oxygen debt. In critically ill and potentially surgical patients, stress and consequent hormonal or metabolic changes can trigger oxygen debt which is associated with worse morbidity and mortality. ⋯ Furthermore, large heterogeneity in clinical trials assessing outcomes benefit of increasing oxygen delivery limits our ability to recommend goal directed fluid therapy aimed at increasing cardiac ouput or higher FiO2. To understand and prevent oxygen debt in critically ill and surgical patients, we need to develop continuous monitoring techniques to assess the balance of oxygen delivery and consumption. Furthermore, methods of increasing oxygen delivery like goal-directed fluid therapy, higher FiO2 and anemia prevention should be rigorously evaluated with focus on establishing outcomes benefit.
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Best Pract Res Clin Anaesthesiol · Dec 2021
ReviewApplication of perioperative hemodynamics today and potentials for tomorrow.
Hemodynamic (HD) monitoring remains integral to the assessment and management of perioperative and critical care patients. This review article seeks to provide an update on the different types of flow-guided HD monitoring technologies available, highlight their limitations, and review the therapies associated with the application of these technologies. Additionally, we will also comment on the expanding roles of HD monitoring in the future.