Articles: postoperative.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2015
[Protective ventilation reduces postoperative pulmonary complications - Contra].
Protective ventilation is a treatment strategy for patients with ARDS. The main goals are the prevention of de-recruitment and overinflation and hence development of VILI. Therefore, protective ventilation is an individualised therapy by adjusting PEEP and Vt in respect to patient' own volume-pressure-curve. ⋯ However, "protective ventilation" has not been standardised yet, and the adequate Vt and PEEP in an individual patient undergoing surgery has still to be clarified. Therefore, due to inconsistent intraoperative ventilation and methodical flaws it remains questionable if a generalized Vt reduction copes this complex topic. One should be aware that reduction of Vt may increase the rate of atelectasis and has been shown to be associated with increased mortality.
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Moya Moya disease (MMD) is one of the most common cerebro-vascular diseases in children resulting in stroke. Surgical revascularization aims at improving the perfusion to the 'at-risk' ischemic brain. Several factors including peri-operative anesthetic related ones, affect the outcome in these children. This study was performed with the aim to explore the role of anesthetic techniques, pharmacological agents and perioperative management strategies on the neurological outcome following an indirect revascularization procedure for the treatment of MMD. ⋯ In this study, anesthetic techniques or medications did not influence the occurrence of postoperative neurological deficits or prolonged hospital stay after an indirect revascularization procedure in children with MMD.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2015
[Perioperative myocardial protection in non-cardiac surgery].
Due to ongoing demographic changes more and more older patients with co-existent cardiac diseases undergo non-cardiac surgery. The risk of postoperative complications, notably myocardial ischemia, is raised in these patients. An accurate preparation before surgery including the risk profile and the management of co-medication is of paramount importance. ⋯ During surgery, tachycardia as well as hypertension and hypotension should be treated consequently. Perioperative myocardial infarction is often asymptomatic and diagnosis can be difficult. Sufficient analgesia is important in postoperative care of patients with co-existing cardiac diseases.