Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2009
ReviewThe impact of the glycocalyx on microcirculatory oxygen distribution in critical illness.
Main problems of critical illness and sepsis are an altered oxygen distribution and microvascular dysfunction linked to tissue oedema. This review seeks to analyse the role of the endothelial glycocalyx in this context. ⋯ Deterioration of the endothelial glycocalyx initiates a breakdown of the vascular barrier in systemic inflammatory response syndrome and sepsis. Preserving this structure in critical illness might be a future therapeutical goal to improve microcirculatory oxygen distribution.
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Curr Opin Anaesthesiol · Apr 2009
ReviewAlterations of mitochondrial function in sepsis and critical illness.
Septic shock is the consequence of a conflict between a pathogenic agent and the immune system of the host. This conflict induces an immune-mediated cytokine storm, with a whole-body inflammatory response often leading to multiple organ failure. Although extensively studied, the pathophysiology of sepsis-associated multiorgan failure remains unknown. One postulated mechanism is changes in mitochondrial function with an inhibition of mitochondrial respiratory chain and a decrease of oxygen utilization. ⋯ A pivotal role is suggested for mitochondrial dysfunction during the occurrence of multiorgan failure. Understanding the precise effect of sepsis on the mitochondrial function and the involvement of mitochondria in the development of multiple organ failure is fundamental. More human studies are thus necessary to clarify the mitochondrial dysfunction in the various phases of sepsis (early and late phase) before testing therapeutic strategies targeting mitochondria.
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Curr Opin Anaesthesiol · Apr 2009
ReviewApplying gases for microcirculatory and cellular oxygenation in sepsis: effects of nitric oxide, carbon monoxide, and hydrogen sulfide.
Nitric oxide, carbon monoxide, and hydrogen sulfide (H2S) are gases that have received attention as signaling molecules regulating many biological processes. All of them were reported to have beneficial effects in inflammatory states, in particular for microcirculatory perfusion and tissue energy balance. Thus, this review will highlight the most important results with a focus on resuscitated, clinically relevant experimental models and, if available, human studies. ⋯ It is still a matter of debate whether manipulating nitric oxide, carbon monoxide, or H2S tissue concentrations, either by using the inhaled gas itself or by administering donor molecules or inhibitors of their endogenous production, is a useful therapeutic approach to improve microcirculatory blood flow, tissue oxygenation, and cellular respiration. This is mainly due to their 'friend and foe character' documented in various experimental models, but also to the paucity of data from long-term, resuscitated large animal experiments that fulfil the criteria of clinically relevant models.
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Curr Opin Anaesthesiol · Apr 2009
ReviewCan anesthesia information management systems improve quality in the surgical suite?
To summarize developments related to the use of anesthesia information management systems (AIMS) and quality assurance and quality improvement. ⋯ Implementation of information technologies in anesthesia as well as in all aspects of healthcare redesigns how patients receive care. AIMS accurately measure, store, query, and recall vital sign data, and enable the systematic analysis of anesthesia-related perioperative data. Using AIMS, quality management programs will be able to study more incidents and analyze them more quickly. Ideally, decision-support systems with practice guidelines delivered via AIMS should help overcome the usual barriers to guideline adherence, and improve care and safety.
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Curr Opin Anaesthesiol · Apr 2009
ReviewImproving safety in the operating room: a systematic literature review of retained surgical sponges.
Gossypibomas are surgical sponges that are unintentionally left inside a patient during a surgical procedure. To improve this patient safety indicator, anesthesiologists will need to work with operating room personnel. This study's goal was to systematically review the literature on retained sponges to identify body location, time to discovery, methods for detection, and risk factors. ⋯ More is being discovered about the patterns leading to a retained sponge. Multidisciplinary approaches and new technologies may help reduce this low frequency but clinically significant event. However, given the complexity of surgical care, eliminating retained sponges may prove elusive.