Current opinion in anaesthesiology
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The role of fluid balance as an important contributor to patient morbidity and mortality in the peri-operative period is only now being understood. Numerous studies in disparate populations undergoing different surgeries suggest that. ⋯ In the absence of level 1 evidence it is difficult to make firm recommendations about practice, though observational and single-centre data suggest a significant survival advantage may be conferred by the peri-operative administration of fluids to monitored physiological targets only. The Australian approach to peri-operative fluid management is to create level 1 evidence. To this end, the development of a large multicentre randomized controlled trial of peri-operative fluid administration is underway.
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Curr Opin Anaesthesiol · Feb 2012
ReviewStrategies to preempt and reduce the use of blood products: an Australian perspective.
Evidence-based patient blood management (PBM) is aimed at achieving better patient outcomes by relying on a patient's own blood rather than on donor blood. This review covers the rationale behind PBM, the treatment modalities involved and the drivers to adopt PBM as a new standard of care. ⋯ High transfusion variability, adverse transfusion outcomes, limited evidence for the benefit of transfusion particularly in elective patients and high cost of transfusion are challenging the traditional transfusion paradigm. National and state-wide initiatives are underway in Australia to broadly implement PBM and PBM programs as a new and cost-effective standard of care in the public health system.
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Curr Opin Anaesthesiol · Feb 2012
ReviewHigh-frequency oscillatory ventilation in adults with acute respiratory distress syndrome.
High-frequency oscillatory ventilation (HFOV) is an attractive alternative to conventional lung protective ventilation. Adequate gas exchange is achieved with very small tidal volumes cycling at a high mean airway pressure. This may prevent injury from inspiratory overdistention and expiratory alveolar collapse. Most patients demonstrate improvements in oxygenation on HFOV though reductions in mortality are lacking. This may be explained by suboptimal technique. In this Opinion, the clinical experience using HFOV in adults in acute respiratory distress syndrome and the evolution of this ventilator technique are reviewed. ⋯ Although HFOV is theoretically appealing and may improve outcomes in adults with acute respiratory distress syndrome, it should be reserved for patients failing conventional ventilation until definitive trials are completed.
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The aim of this review is to underline the need for an adequate clinical and functional evaluation of respiratory function and asthma control in patients undergoing surgical procedures requiring general anesthesia to obtain useful information for an adequate preoperative pharmacological approach. ⋯ A better control of asthma must be considered the 'gold standard' for a patient at 'a reasonable low risk' to develop perioperative/postoperative bronchospasm. International consensus promoted by pulmonologists, anesthesiologists, and allergists might be useful to define a better diagnostic and therapeutic approach.
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Curr Opin Anaesthesiol · Feb 2012
ReviewStrategies to reduce the use of blood products: a US perspective.
To describe the recent developments in the strategies to reduce allogeneic blood transfusions with emphasis on the impact on clinical outcomes. ⋯ Patient blood management is the timely use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcome.