Articles: function.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCerebral near-infrared spectroscopy in perioperative management of left ventricular assist device and extracorporeal membrane oxygenation patients.
Spinal cord ischemia after thoracoabdominal aortic interventions is a devastating complication because it significantly worsens the perioperative morbidity and mortality. Long-term outcome is also affected because of medical complications which are directly related to the neural deficits. Paraplegia has significant medical, social, and financial aspects. Limited mobility, the need for assistance in activities of daily living, makes paraplegia an important target for prevention. An understanding of spinal cord blood supply, risk factors for spinal ischemia, and strategies for spinal cord rescue in this setting can help minimize the negative outcome effects of this important complication. ⋯ The progression of spinal cord ischemia after thoracoabdominal aortic interventions can frequently be arrested before irreversible infarction results. This spinal cord rescue depends on the early detection and immediate multimodal intervention to maximize spinal cord oxygen supply. The devastating outcomes associated with spinal infarction in this setting offset the risks and knowledge gaps currently associated with contemporary interventions.
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Curr Opin Anaesthesiol · Feb 2014
ReviewPain and inflammatory response following off-pump coronary artery bypass grafting.
Inflammation and pain are two common clinical issues following cardiac surgery, which are important to patient outcomes. This article reviews the literature regarding inflammation and pain following cardiac surgery with special emphasis on off-pump cardiac surgery. ⋯ Off-pump cardiac surgeries although known to decrease the inflammatory burden do not appear to impact the overall patient outcomes. Recent evidence indicates the prothrombotic tendency following off-pump procedures, which could be related to the time course of inflammation following off-pump cardiac surgery. There might be some benefit of off-pump procedures regarding neurological and renal function that needs further studies. Pain management following off-pump procedures is similar to that of patients undergoing on-pump cardiac surgery. Better caregiver and patient education is crucial for improving pain control following cardiac surgery. Analgesic regimens need to consider adjuvants and regional analgesic techniques and patient-controlled modalities while providing care.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCritical care strategies to improve neurocognitive outcome in thoracic surgery.
This review focuses on neurocognitive outcome with respect to potential pathophysiological inflammatory mechanisms of thoracic surgery and one-lung ventilation, risk factors of postoperative delirium and postoperative cognitive dysfunction (POCD) as well as anti-inflammatory strategies. ⋯ There is evidence that important key strategies improve neurocognitive outcome after thoracic surgery. This includes adequate risk stratification, the anesthetic management and postoperative critical care strategies.
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The relative importance of respiratory viral infections vs inhalant allergy in asthma pathogenesis is the subject of ongoing debate. Emerging data from long-term prospective birth cohorts are bringing increasing clarity to this issue, in particular through the demonstration that while both of these factors can contribute independently to asthma initiation and progression, their effects are strongest when they act in synergy to drive cycles of episodic airways inflammation. An important question is whether susceptibility to infection and allergic sensitization in children with asthma arises from common or shared defect(s). ⋯ The effects of these defects in DCs from children wtih asthma are accentuated by parallel attenuation of innate immune functions in adjacent airway epithelial cells that reduce their resistance to the upper respiratory viral infections, which are the harbingers of subsequent inflammatory events at asthma lesion site(s) in the lower airways. An important common factor underpinning the innate immune functions of these unrelated cell types is use of an overlapping series of pattern recognition receptors (exemplified by the Toll-like receptor family), and variations in the highly polymorphic genes encoding these receptors and related molecules in downstream signaling pathways appear likely contributors to these shared defects. Findings implicating recurrent respiratory infections in adult-onset asthma, much of which is nonatopic, suggest a similar role for deficient immune surveillance in this phenotype of the disease.
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Semin Respir Crit Care Med · Feb 2014
ReviewHigh-Resolution CT of Interstitial Lung Disease: A Continuous Evolution.
Before the advent of high-resolution computed tomography (HRCT), the role of imaging, chest radiography in particular, in the management of patients with interstitial lung disease was limited. In the past 25 years, this has radically changed. HRCT has transformed the diagnostic landscape by providing detailed cross-sectional imaging of the lungs, which permit ready identification of a variety of different interstitial lung diseases. ⋯ Recently, HRCT data have been integrated with pulmonary function in staging models to predict prognosis particularly in idiopathic fibrosing lung disease. This article reviews these stages of evolution. The emergence of the multidisciplinary approach to diagnosis will also be considered.