Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2010
Review Case ReportsTherapeutic hypothermia and traumatic brain injury.
Therapeutic hypothermia after traumatic brain injury (TBI)? For the last 10 years, no topic has been more popular and more controversial among neurointensivists. This article reviews the most current findings (experimental, clinical, adult and pediatric TBI), as well as the clinical management of therapeutic hypothermia. ⋯ Taking into consideration all results from clinical hypothermia TBI studies discussion has to be focused around the possibility that a better outcome could be achieved if protocols for therapeutic hypothermia are reviewed. It is possible that the negative effects of the cooling and the rewarming procedure currently overshadow the neuroprotective effects.
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Curr Opin Anaesthesiol · Apr 2010
ReviewRespiratory failure and hypoxemia in the cirrhotic patient including hepatopulmonary syndrome.
Liver cirrhosis and portal hypertension present with three unique pulmonary complications that are the subject of ongoing clinical research: hepatopulmonary syndrome, portopulmonary hypertension (POPH), and hepatic hydrothorax. The present article is based on a review of the current literature on how to manage these disorders, which are highly important to both anesthesiologists and intensive care physicians. ⋯ Patients with end-stage liver disease are at risk for respiratory failure and hypoxemia and need to be screened for hepatopulmonary syndrome, POPH, and hepatic hydrothorax. Failure to timely recognize and adequately treat these complications of cirrhosis may have severe consequences.
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Trauma patients requiring massive transfusion represent a population at high risk for potentially preventable death. This review describes recent advances in the early recognition and treatment of the coagulopathy of trauma, as well as ongoing work to define optimal resuscitation strategies. ⋯ As optimal resuscitation strategies continue to evolve, recent efforts have focused on early and aggressive treatment of coagulopathy, with higher ratios of plasma and platelets to red blood cells transfused. Early evidence suggests that such strategies have a beneficial outcome in regards to trauma-related mortality.
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The present review examines the trends and controversies on how perioperative care can influence outcome after anesthesia and surgery. ⋯ The use of a surgical checklist may reduce postoperative mortality and complications in surgical patients. The optimal dosing and timing of perioperative beta-blockade should decrease the incidence of postoperative stroke. However, to date, the long-term risk:benefit balance of attenuation of the perioperative stress response remains controversial. Red cell transfusion is unavoidable in some cases, but is associated with worsened outcome in various surgical situations. Future research should focus on the risk:benefit balance of anesthesia and surgery. This will contribute to promoting the role of anesthesiologists as physicians of the perioperative period.
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Curr Opin Anaesthesiol · Apr 2010
ReviewFuture opportunities and challenges in academic anesthesia in the United Kingdom: a model for maintaining the scientific edge.
This review outlines the methodology of a major report into academic strategy recently undertaken by the Royal College of Anaesthetists in the United Kingdom. Analyzing the factors that made the report's conclusions robust and workable provides lessons for other countries or healthcare systems faced with similar problems in academic anesthesia. ⋯ The review's main conclusions are: the creation of a central National Institute for Academic Anaesthesia to coordinate and implement academic strategy and funding; engaging with national pathways for the training of future academics; and suggestions for the future role for anesthetic specialist societies in academic strategy. These initiatives can radically transform the research environment in a positive way.