Articles: postoperative.
-
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.
-
Cerebral oximetry, though first described for clinical use in cardiac surgery, has been increasingly used in the setting of thoracic surgery. Research focusing on the use of cerebral oximetry in this setting is relatively sparse. This review outlines our current understanding of the use of cerebral oximetry for thoracic surgery. ⋯ Although it is clear that cerebral desaturation can commonly occur during thoracic surgery, it is partly dependent upon how desaturation is defined. The relationship between cerebral desaturation and adverse outcomes after thoracic surgery, as well as the potential ability for cerebral oximetry to guide therapeutic modalities, awaits much needed additional research before being more widely accepted.
-
Curr Opin Anaesthesiol · Feb 2014
ReviewUpdate on minimally invasive hemodynamic monitoring in thoracic anesthesia.
Advanced hemodynamic monitoring is indispensable for adequate management of patients undergoing major surgery. This article will summarize minimally invasive hemodynamic monitoring technologies and their potential use in thoracic anesthesia. ⋯ Many different minimally invasive hemodynamic monitoring devices have been developed and clinically introduced in the last years. They offer the advantage of being less invasive and easier to use. However, these techniques have several limitations and data are scarce in patients undergoing thoracic anesthesia, preventing their widespread use so far.
-
The purpose of this article is to review the literature and to highlight current practice regarding the management of the chronic pain patient presenting for surgery. ⋯ Successful management of the complex pain patient requires knowledge of the art and science of perioperative medicine.
-
Efficient and safe pediatric perioperative pain therapy in the context of a multimodal pain therapy concept requires a slight to moderate opioid analgesic. Nalbuphine is a nearly ideal opioid for this purpose due to its unique pharmacological properties as a μ-receptor antagonist/κ-receptor agonist and a high safety profile. Nalbuphine is used clinically primarily in postoperative pain therapy administered as a bolus, continuous infusion and patient-controlled analgesia. Furthermore, it is administered in different regimens for pediatric diagnostic and interventional sedation.