Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2009
ReviewAnesthesia in adult patients with congenital heart disease.
Recent advances in prenatal diagnosis, interventional cardiology, pediatric cardiac surgery, anesthesia, and critical care have resulted in an increasing number of adult patients with congenital heart disease (CHD). Most of these patients will require noncardiac surgery thus presenting a new challenge for anesthesiologists. The purpose of this article is to summarize preoperative and intraoperative implications for the anesthesiologist in the noncardiac surgery setting. ⋯ The number of adult patients with CHD is now superior to the number of children. This is a new challenge for anesthesiologist in the noncardiac surgery settings.
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Epidurals have been used for cardiac surgery for more than 20 years. The worldwide-published use is now large enough to determine that there is no additional risk for epidural use in cardiac versus noncardiac surgery. ⋯ Fear of an increased risk of epidural haematoma has largely prevented increased use of this technique for cardiac surgery. Clinicians can be reassured that the risk of epidural use in cardiac surgery is similar to that for noncardiac surgery, which provides a new platform for considering risk versus benefit in their practice.
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Curr Opin Anaesthesiol · Feb 2009
ReviewManagement of mini-cardiopulmonary bypass devices: is it worth the energy?
To address the role of mini-cardiopulmonary bypass systems in cardiac operations, with specific respect to clinical outcome. ⋯ Mini-cardiopulmonary bypass systems reduce the need for allogeneic blood transfusions. Other improvements in postoperative outcome are more debated. They require a long learning curve and are more expensive. A cost analysis based on a large randomized controlled trial is still needed to clarify the potential future role of these systems in clinical practice.
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Curr Opin Anaesthesiol · Feb 2009
ReviewCurrent aspects of perioperative fluid handling in vascular surgery.
Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate existing data when planning perioperative fluid management. This review aims to summarize the underlying facts. ⋯ The basis of fluid therapy in vascular surgery is a careful differential indication of the respective classes of preparations. A goal-directed approach might help to avoid hypovolaemia.
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Curr Opin Anaesthesiol · Feb 2009
ReviewUpdate on the role of paravertebral blocks for thoracic surgery: are they worth it?
To consider optimal analgesic strategies for thoracic surgical patients. ⋯ There is good evidence that paravertebral block can provide acceptable pain relief compared with thoracic epidural analgesia for thoracotomy. Important side-effects such as hypotension, urinary retention, nausea, and vomiting appear to be less frequent with paravertebral block than with thoracic epidural analgesia. Paravertebral block is associated with better pulmonary function and fewer pulmonary complications than thoracic epidural analgesia. Importantly, contraindications to thoracic epidural analgesia do not preclude paravertebral block, which can also be safely performed in anesthetized patients without an apparent increased risk of neurological injury. The place of paravertebral block in video-assisted thoracoscopic surgery is less clear.