Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2012
ReviewPlace of the colloids in fluid resuscitation of the traumatized patient.
The examination of the recent literature aimed at analysing the most recent data that could affect decisions regarding the use of colloids in trauma resuscitation. ⋯ Recent trauma studies provide ongoing, but not conclusive, evidence of a benefit from colloid resuscitation in trauma.
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Curr Opin Anaesthesiol · Apr 2012
ReviewPreoperative optimization: rationale and process: is it economic sense?
The development of preoperative clinics and the increasing importance of the anaesthetist in the management of surgical risk have expanded the concept of preoperative optimization. This review will focus on the rationale and process for cost-effective preoperative optimization. ⋯ The requirement for appropriate methods of risk stratification of surgical patients targeted at the reduction of postoperative morbidity, underpins the development of cost-effective preoperative optimization. Specific process-based and clinical measures may then be applied to the development of individualized perioperative care packages.
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Curr Opin Anaesthesiol · Apr 2012
ReviewCoagulation monitoring of the bleeding traumatized patient.
Death due to trauma is the leading cause of lost life years worldwide, with haemorrhage being responsible for 30-40% of trauma mortality and accounting for almost 50% of the deaths in the initial 24 h. On admission, 25-35% of trauma patients present with coagulopathy, which is associated with a several-fold increase in morbidity and mortality. ⋯ This article reviews the basic principles of VHA, the correlation between the VHA whole blood clot formation in accordance with the cell-based model of haemostasis, the current use of VHA-guided therapy in trauma and limitations of VHA.
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Opt-in or opt-out consent for organ transplantation is still a disputed subject and the determination of the more appropriate system is still debated. ⋯ Consent for organ donation in a brain dead patient represents an act of benevolence or of solidarity in favour of an unknown person. If one considers that the principle of autonomy must prevail over the principle of benevolence or of solidarity, the risk is depriving a potential recipient of a comparatively very important benefit. On the contrary, if one considers that the principles of benevolence should necessarily lead, the risk is high of exerting an excessive pressure to the detriments of autonomy and liberty of the individual. Whatever the system chosen, adequate and fair communication expressing loyally the way families are approached is essential.