Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2008
ReviewRole of glutamine supplementation in critically ill patients.
To update the documentation concerning the clinical use of glutamine supplementation in critically ill patients. Outcome, patient safety and future plans are examined. ⋯ The use of intravenous glutamine supplementation in critically ill patients on total parenteral nutrition is currently the standard of care. The use of exogenous glutamine supplementation in critically ill patients on enteral nutrition is still not supported by sufficient evidence. The use of plasma glutamine concentration as an indicator for glutamine deficiency and a possible indicator for supplementation is suggested.
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Curr Opin Anaesthesiol · Apr 2008
ReviewTeamwork and the legal and ethical responsibility of the anaesthetist.
Anaesthetists are members of the operating team. Although the surgeons usually consider themselves to be the leaders of the team, all members, including the anaesthetist, have their own legal, ethical and professional responsibilities. ⋯ Anaesthetists have to be more aware of their position in the care team and pay more attention to their legal, ethical and professional responsibilities.
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Curr Opin Anaesthesiol · Apr 2008
ReviewTargeting the lipopolysaccharides: still a matter of debate?
The intention of this article is to review endotoxin, host response to endotoxin, clinical significance of endotoxemia, past failed therapies targeting endotoxin, current therapeutic efforts in this area and the authors' opinion on the future of such therapy. ⋯ The benefits of therapies targeting endotoxin remain to be elucidated. Clinical trials targeting populations with documented endotoxemia are more likely to provide an adequate test of this therapeutic approach. Prophylaxis of high-risk populations should also be considered.
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Curr Opin Anaesthesiol · Apr 2008
Review Comparative StudyParamedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept.
Much controversy exists about who can provide the best medical care for critically ill patients in the prehospital setting. The Anglo-American concept is on the whole to provide well trained paramedics to fulfil this task, whereas in some European countries emergency medical service physicians, particularly anaesthesiologists, are responsible for the safety of these patients. ⋯ Evidence suggests that some critically ill patients benefit from the care provided by an emergency physician-based emergency medical service, but further studies are needed to identify the characteristics and early recognition of these patients.
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The traditional approach to trauma patients with presumed internal hemorrhage has been immediate, aggressive intravenous fluid resuscitation. Recent experimental and clinical data, however, suggest a more discriminating approach that first considers concurrent head injury, hemodynamic stability and the presence of potentially uncontrollable hemorrhage (e.g. deep truncal injury) versus a controllable source (e.g. distal extremity wound) as well as the use of new techniques to inhibit bleeding and better ways to monitor the patient's condition. ⋯ Owing to the growing societal threat of trauma, further research, including studies already under way, will be critical to delineate the timing and technique of infusing advantageous resuscitative fluids such as hypertonic saline and hemoglobin-based oxygen carriers as well as the use of hemostatic agents and special blood products.