Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthesia for minimally invasive gastric and bowel surgery.
It is of great importance that anaesthetic regimens match surgical procedures in regard to surgical time, in reducing organ dysfunction elicited by the anaesthesia and surgical trauma and by providing optimal post-operative pain treatment, leaving the possibility of early mobilization. New, rapidly eliminated anaesthetic drugs are, by virtue of their pharmacodynamic and pharmacokinetic profiles, optimal for use; combined with continuous thoracic epidurals with local anaesthetics and low-dose opioids, these drugs may permit reduction of various post-operative complications. ⋯ Few studies have evaluated whether these changes affect surgical outcome and whether or not different anaesthetic regimens influence relevant morbidity parameters. In future documentation it is important that controlled, well-designed clinical studies evaluate how the advantages from multimodal anaesthetic techniques improve relevant surgical outcome.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthesia for minimally invasive cardiac surgery.
Minimally invasive cardiac surgery is used for both extracardiac and intracardiac procedures. Extracardiac procedures, such as coronary artery bypass grafting, are often performed on a beating heart. Intracardiac procedures are done with the aid of cardiopulmonary bypass. ⋯ Patient selection is important to avoid intra-operative and post-operative complications. Prolonged single-lung ventilation, incomplete revascularization in hybrid procedures, and limited access for rapid intervention pose challenges with patient management. Conversion to sternotomy that may be required occasionally and extension of portals over several dermatomal segments mandate a versatile analgesic technique.
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Anaesthetic requirements for endovascular surgery for aortic, carotid and peripheral vascular disease are reviewed. Peculiarities of the surgery which may impinge on anaesthetic management are discussed together with the pre-operative assessment issues of particular relevance to patients with generalized vascular disease. The detailed anaesthetic management for carotid and aortic endovascular repair is addressed. The lowered peri-operative stress and general morbidity levels which occur with endovascular surgery allow sicker patients with greater risk factors to present for this type of surgery, thus increasing the challenges facing anaesthetists.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthesia, minimally invasive surgery and pregnancy.
Minimally invasive surgery is being performed more frequently in pregnant patients. Numerous published reports have documented the safety and advantages of laparoscopic cholecystectomy and laparoscopic appendectomy during pregnancy. ⋯ We also describe our approach to anaesthetic management for minimally invasive surgery during pregnancy. With appropriate precautions, including vigilant monitoring and anticipation and treatment of the potential adverse effects of carbon dioxide pneumoperitoneum, anaesthesiologists may provide safe care for these patients, and pregnant women can benefit from the advantages of minimally invasive surgery.
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Best Pract Res Clin Anaesthesiol · Mar 2002
ReviewAnaesthetic considerations for hysteroscopic surgery.
Use of the hysteroscope in modern gynaecological practice continues to develop as a diagnostic and management tool for intrauterine disease. Operative hysteroscopy (OH) is now an accepted alternative to hysterectomy for women with menorrhagia. The advantages of OH are associated with its short operating time, rapid post-operative recovery and low morbidity. ⋯ There are no controlled studies comparing different anaesthetic techniques for OH. Regional anaesthesia may offer an advantage over general anaesthesia because it enables early detection of fluid overload. Great care should be taken when positioning the patient to prevent peripheral neuropathy.