Current opinion in anaesthesiology
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To discuss the pathophysiology, risk factors, and treatments for atrial fibrillation occurring after cardiac surgery. ⋯ Atrial fibrillation is one of the most common complications of cardiac surgery. There are three major aims for treating atrial fibrillation: conversion to sinus rhythm, heart rate control, and anticoagulation. Only beta-blockers can be recommended for prophylaxis against postoperative atrial fibrillation. Further refinements in surgical treatments for atrial fibrillation may allow for wider applications of this therapy with lower rates of complications.
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Recent articles indicate that at the present time disastrous respiratory outcomes during the perioperative management of patients with obstructive sleep apnea are a major problem for the anesthesia community. ⋯ Adult obese patients with suspected or sleep test confirmed obstructive sleep apnea present a formidable challenge throughout the perioperative period. Tracheal intubation and extubation decisions in obese patients with either a presumptive or sleep study diagnosis of obstructive sleep apnea must be made within the context that there may be excess tissue in the pharynx. If opioids are used in the extubated postoperative obese patient with sleep apnea, then one must seriously consider the need for continuous visual and electronic monitoring. Institutional and national society guidelines on these matters are badly needed.
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Curr Opin Anaesthesiol · Feb 2004
Fiberoptic bronchoscopy need not be a routine part of double-lumen tube placement.
The debate continues as to whether a fiberoptic bronchoscope must be used to position a double-lumen tube. This review supports the argument that although bronchoscopy is extremely helpful, it is not always needed for the routine placement of left double-lumen tubes. ⋯ Although bronchoscopy is useful, no double-lumen tube positioning method is fail-safe. The choice of which approach to use, 'blind' versus fiberoptic bronchoscope-assisted, is influenced by many factors. Operator experience with any method increases the likelihood of success. A fiberoptic bronchoscope is not always needed for left double-lumen tube placement.
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Increasing experimental evidence is indicating that volatile anesthetic agents may exert direct cardioprotective effects. They have been shown to directly precondition or indirectly enhance ischemic preconditioning. This results in protection against reversible and irreversible ischemic myocardial damage. In addition, volatile anesthetics also decrease the extent of the reperfusion injury when administered only during the reperfusion period. The implementation of these properties during clinical anesthesia might provide an additional tool in the treatment and prevention of ischemic cardiac dysfunction in the perioperative period. ⋯ This review will summarize the current knowledge in this field and also discuss the potential mechanisms involved in cardioprotection by anesthetic agents.