Current opinion in anaesthesiology
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Anesthesiologists may face problematic situations when patients are close to death, in which clinical problems, decision-making processes, and ethical issues are often interconnected and dependent on each of them. The aim of this review is to assess the recent literature regarding the anesthesiological role for advanced cancer patients. ⋯ Anesthesiologists should be competent in all aspects of terminal care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. More research is needed to provide models which should be spread in the scientific community to afford this difficult task.
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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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The use of simulation in medicine has grown significantly over the past 2 decades. Simulation in obstetric anesthesia can be divided into four broad uses: technical skills, nontechnical or teamwork skills, individual clinical competence, and the safety of the clinical environment. This review will describe recent trends in the use of simulation in several of these categories. ⋯ As the use of simulation continues to grow, research should concentrate on whether anesthesia or teamwork skills learned in the simulated environment change behavior and improve outcomes in the clinical setting. More instructional publications would also facilitate the growth into more clinical environments.
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Curr Opin Anaesthesiol · Jun 2012
ReviewAnesthetic management in patients undergoing hyperthermic chemotherapy.
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an important therapeutic option for selected patients with peritoneal surface malignancies. This aggressive multimodality treatment is complex, not only regarding surgical technique, but also regarding anesthesia. The present review represents our experience in anesthetic care. ⋯ Anesthetic management importantly contributes to the containment of the perioperative complications of HIPEC. An appreciation of the technical aspects and physiologic disruptions associated with intra-abdominal HIPEC is critical to ensure effective anesthetic management. Although data on this specialized surgical procedure are scarce, some referral centers have accumulated extensive experience. This article reviews the current knowledge about the anesthesiological and intensive care management of patients undergoing HIPEC. It pinpoints strategies for perioperative monitoring as well as illustrates alterations in hemodynamic, hematopoetic, and fluid hemostasis.
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Curr Opin Anaesthesiol · Jun 2012
ReviewAnesthetic considerations for the patient with liver disease.
An increasing number of patients requiring surgery are presenting with chronic or end stage liver disease. The management of these patients demands anesthesiologists with in-depth knowledge of the consequences of hepatic dysfunction, the effects on other organs, the risk of surgery, and the impact of anesthesia. ⋯ Current studies have employed different anesthetic approaches in the preoperative and intraoperative management in order to improve outcomes of patients with liver disease.