Current opinion in anaesthesiology
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Recent advances were made in the field of point-of-care ultrasound (POCUS). Thoracic and lung ultrasound have become a rapid and accurate method of diagnosis of hypoxic diseases. The purpose of this article is to review the recent literature on POCUS, emphasizing on its use in the operating room. ⋯ POC thoracic and lung ultrasound is used in many critical medicine fields. The aim of this review is to describe the basic lung ultrasound technique and the knowledge required in order to diagnose and treat the hypoxic patient. Emphasis is on disorder such as pleural effusion, alveolar interstitial disease, as well as pneumothorax, which is of particular importance in the field of anesthesiology.
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Curr Opin Anaesthesiol · Feb 2013
ReviewPerioperative coagulation management during cardiac surgery.
Cardiac surgery patients commonly present bleeding complications that negatively influence patient's clinical outcome. Therefore, fast and detailed diagnoses as well as early and specific therapy of perioperative coagulopathy are of high clinical relevance. The so-called point-of-care (POC) methods for coagulation analyses are increasingly used in perioperative care. It is the purpose of this review to present modern aspects of coagulation management, discuss the effect of the implementation of POC methods in perioperative care, and present substantial components of hemotherapy algorithms to manage coagulopathy in cardiac surgery patients. ⋯ Prospective randomized multicenter studies are needed to confirm the hypothesis that algorithm-based specific hemotherapy in conjunction with POC testing minimizes patient's exposure to blood products and improves clinical outcome.
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This review will analyze the risk factors of acute lung injury (ALI) in patients undergoing thoracic surgery. Evidence for the occurrence of lung injury following mechanical ventilation and one-lung ventilation (OLV) and the strategies to avoid it will also be discussed. ⋯ The goal of ventilation is to minimize lung trauma by avoiding overdistension and repetitive alveolar collapse, while providing adequate oxygenation. Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also involves positive end-expiratory pressure, lower FiO(2), recruitment maneuvers, and lower ventilatory pressures.
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To discuss the innovations in general thoracic surgery and how they affect anesthetic management perioperatively. However, rather than listing various thoracic procedures and their inherent issues that complicate providing anesthesia, the approach of this article is to raise the anesthetic issues associated with innovations in thoracic surgery perceived to be important by the thoracic surgeon. ⋯ Innovations in thoracic surgery continually emerge and challenge thoracic surgeons and anesthesiologists to evaluate their utility and benefits. The increased adoption of minimally invasive operations is a testament to this collaboration. This process requires an ongoing dialog between the clinicians within these two disciplines to advance the science of surgery.
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Curr Opin Anaesthesiol · Feb 2013
ReviewPreoperative identification of patients with increased risk for perioperative bleeding.
Although the overall complication rate in cardiac surgery has been decreased, perioperative bleeding increasing morbidity and mortality is still frequent. Furthermore, the widespread use of new antithrombotic and antiplatelet agents presents an additional challenge in daily practice. Therefore, identifying patients with increased bleeding risk would be advantageous to optimize perioperative management. ⋯ Apart from precise bleeding history only insufficient data exist in cardiac surgery to exactly predict bleeding complications. Therefore, there is urgent need for further studies to improve perioperative bleeding management.