Best practice & research. Clinical anaesthesiology
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Rapid atrial arrhythmias affect close to one million elderly Americans who undergo cardiac or non-cardiac operations annually and have been associated with prolonged hospital stays. In contrast, bradyarrhythmias or ventricular arrhythmias severe enough to require treatment occur in less than 1% of patients who undergo all types of surgery, including cardiac. ⋯ New approaches directed at prophylaxis and acute therapy of atrial arrhythmias are discussed, as are recommendations to prevent thromboembolic events. Practice and research agenda are proposed.
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Airway management is a critical part of anaesthesia practice. Management includes mask ventilation, laryngoscopy, endotracheal intubation and extubation of the patient. ⋯ The American Association of Anesthesiologists (ASA) developed and recently revised guidelines for the management of the difficult airway. These guidelines focus on strategies for intubation as well as alternative airway techniques that can be used when a patient with a difficult airway is encountered.
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Diabetes mellitus is now classified as either 'type 1' (failure of endogenous insulin production) or 'type 2' ('insulin resistance') and can be diagnosed if fasting blood glucose is >6.1 mmol/l (110mg/dl) on two separate occasions or there is unequivocal hyperglycaemia with acute metabolic decompensation or obvious symptoms. The prevalence of the disease is rising and may be as great as 12-14% in western populations aged over 40 years. ⋯ It is associated with increased perioperative mortality and morbidity. Evidence is now accumulating that intensive glycaemic monitoring and the administration of insulin infusions to achieve tight glycaemic control are associated with an improvement of both perioperative mortality and morbidity.
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Best Pract Res Clin Anaesthesiol · Dec 2004
ReviewStrategies of neuroprotection for intracranial aneurysms.
Neuroprotection for patients with intracranial aneurysms encompasses the preservation of brain cells endangered by a limited blood and oxygen supply due to aneurysm rupture, clipping or coiling, as well as vasospasm. A large variety of prophylactic and therapeutic neuroprotective strategies have been proposed, but success in human disease is quite limited. ⋯ New concepts are ischaemic preconditioning, growth factors, and gene therapy. Each strategy is rated on underlying evidence, and research agendas are mentioned.
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Despite advances in our understanding of the neurobiology of nociception, postoperative pain continues to be undertreated. There are many modalities that may provide effective postoperative analgesia, including systemic (e.g. opioids, non-steroidal anti-inflammatory agents) and regional analgesic options. The particular modality or modalities utilized for a particular patient will depend on the risk-benefit profile and patient preferences. Ideally, analgesic options should be incorporated into a multimodal approach to facilitate patient recovery after surgery.