Current opinion in anaesthesiology
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To provide an update on fast track thoracic anesthesia for patients undergoing lung resection. ⋯ Fast track in thoracic surgery and anesthesia has evolved quite slowly in contrast to other surgical specialties; further studies are needed to weigh the risks and benefits in thoracic surgical patients in order to determine who can benefit from the concept of fast track.
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Pneumonectomy has the highest perioperative risk among common pulmonary resections. The purpose of this review is to update clinicians on the importance of anesthetic management for these patients. ⋯ Patients should have a preoperative assessment of their respiratory function in three areas: lung mechanical function, pulmonary parenchymal function and cardiopulmonary reserve. Interventions that have been shown to decrease the incidence of respiratory complications include cessation of smoking, physiotherapy and thoracic epidural analgesia. Extrapleural pneumonectomy and sleeve pneumonectomy are surgical variations that place specific increased demands on the anesthesiologist. The rare but treatable complication of cardiac herniation must always be remembered as a potential cause of life-threatening hemodynamic instability in the early postoperative period.
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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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The present review evaluates the evidence available in the literature tracking perioperative mortality and morbidity as well as the pathogenesis and management of acute lung injury (ALI) in patients undergoing thoracotomy. ⋯ Knowledge of the perioperative risk factors of major complications and understanding of the mechanisms of postthoracotomy ALI enable anesthesiologists to implement 'protective' lung strategies including the use of low tidal volume (VT) with recruitment maneuvers, a goal-directed fluid approach and prophylactic treatment with inhaled beta2-adrenergic agonists.