Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2007
ReviewWhich device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers.
This review is a clinical comparison between double-lumen endotracheal tubes and bronchial blockers to determine which device is considered the best for lung isolation. ⋯ Double-lumen endotracheal tubes and bronchial blockers should be part of the armamentarium of every anesthesiologist involved in lung isolation techniques and every device should be tailored to specific case needs.
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To report the impact of atelectasis on perioperative outcomes. Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance and development of lung injury. Here, we examine the etiology, contributing factors, consequences, diagnosis and treatment of atelectasis. ⋯ Atelectasis in the presence of preexisting lung disease or limited cardiopulmonary reserve may have significant consequences. Increasing understanding of the underlying nature of atelectasis and its contribution to acute lung injury will improve our approach to the prevention and management of atelectasis.
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Rapid atrial arrhythmias affect the elderly who undergo cardiac or noncardiac operations annually and have been associated with prolonged hospital stays. This article focuses on new issues leading to the improved understanding of the pathophysiology and mechanisms of postoperative atrial arrhythmias. ⋯ Recent approaches directed at prophylaxis and acute therapy of atrial arrhythmias are discussed as are recommendations to prevent thromboembolic events.
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Curr Opin Anaesthesiol · Feb 2007
ReviewAnesthesia for thoracic surgery in morbidly obese patients.
This review considers the anesthetic management of obese patients undergoing thoracic surgery. Extremely or morbidly obese patients differ from patients of normal weight in several ways. Obese patients have altered anatomy and physiology, and usually have associated comorbid medical conditions that may complicate their operative course and increase their risks for postoperative complications. ⋯ With proper attention to their special needs, the morbidly obese patient can safely undergo thoracic surgery and one-lung ventilation.
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To review the current anaesthetic management of patients undergoing transthoracic oesophagectomy. ⋯ Although nonsurgical treatments are being developed, at present surgery remains the mainstay of potentially curative treatment. Accurate risk stratification would greatly facilitate the assessment of strategies to reduce operative mortality. Anaesthetic research has the potential to further improve the safety of patients undergoing oesophageal surgery.