Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2012
ReviewShould antifibrinolytics be given in all patients with trauma?
Hemorrhage is the second most important cause of death in patients with trauma, contributing to approximately 30% of trauma-related mortality. Pharmacological prohemostatic agents may be useful adjunctive treatment options in patients with severe blood loss. ⋯ In view of this efficacy and safety of this relatively cheap and simple drug, it may be recommended to put tranexamic acid in the first (maybe even prehospital) line of management of patients with severe traumatic hemorrhage.
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Along with the increasing population of elderly people in developed countries, anesthesiologists have increasing opportunities to anesthetize cancer patients in their routine work. However, no guideline of anesthesia procedures for cancer patients is available even though guidelines of operative procedures have been formulated for different types of cancer. This review provides recent findings related to the optimal choice of anesthetics and adequate anesthesia management for cancer patients. ⋯ Accumulated basic and clinical data suggest that total intravenous anesthesia with propofol, cyclooxygenase antagonists, and regional anesthesia can decrease negative consequences associated with perioperative immunosuppression. Volatile anesthesia, systemic morphine administration, unnecessary blood transfusions, intraoperative hypoxia, hypotension, hypothermia, and hyperglycemia should be avoided.
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Supplemental oxygen is often administered during anesthesia and in critical illness to treat hypoxia, but high oxygen concentrations are also given for a number of other reasons such as prevention of surgical site infection (SSI). The decision to use supplemental oxygen is, however, controversial, because of large heterogeneity in the reported results and emerging reports of side-effects. The aim of this article is to review the recent findings regarding benefits and harms of oxygen therapy in anesthesia and acute medical conditions. ⋯ The benefits of supplemental oxygen are not yet confirmed, and new findings suggest that potential side-effects should be considered if the inspired oxygen concentration is increased above what is needed to maintain normal arterial oxygen saturation.
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Common colds are infections of mostly viral origin that frequently occur in childhood. The overall anesthetic risk in children with respiratory tract infections is increased because of the increased incidence of perioperative respiratory adverse events (PRAEs). Although the morbidity and mortality of PRAE are low when managed by experienced anesthesiologists, careful preoperative assessment and perioperative anesthetic care are indispensable. ⋯ Children with a cold can be safely anesthetized under certain circumstances; however, anesthesia in children with symptomatic infections with wheezing, purulent secretion, fever and reduced general condition should be postponed for at least 2 weeks. Anesthetic treatment options for children with infection of the upper airway with a runny nose and cough include preoperative inhalational therapy with salbutamol, avoidance of endotracheal intubation whenever possible, use of a face mask or laryngeal mask, intravenous induction with propofol and avoidance of desflurane. Prevention, early recognition and immediate treatment of complications by an experienced anesthesiologist are crucial.
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Curr Opin Anaesthesiol · Jun 2012
ReviewRenin-angiotensin system inhibitors and angioedema: anesthetic implications.
Angioedema is a serious complication of renin-angiotensin system inhibitor therapy. The incidence is 0.1-0.7%. It consists of nonpitting edema and involves the face and lips. In severe cases, it extends to pharyngeal and laryngeal structures. ⋯ Trauma of the airway, especially during difficult intubation, may precipitate severe angioedema. In cases with laryngeal involvement, fiberoptic intubation may be necessary. After the episode of angioedema, lifetime discontinuation of all renin-angiotensin inhibitors may be warranted.