Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2014
ReviewCritical care strategies to improve neurocognitive outcome in thoracic surgery.
This review focuses on neurocognitive outcome with respect to potential pathophysiological inflammatory mechanisms of thoracic surgery and one-lung ventilation, risk factors of postoperative delirium and postoperative cognitive dysfunction (POCD) as well as anti-inflammatory strategies. ⋯ There is evidence that important key strategies improve neurocognitive outcome after thoracic surgery. This includes adequate risk stratification, the anesthetic management and postoperative critical care strategies.
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Curr Opin Anaesthesiol · Feb 2014
ReviewNew developments in the treatment of acute pain after thoracic surgery.
This review examines recent advances and findings in the field of pain management in patients undergoing thoracic surgery. ⋯ Pain after thoracic surgery has a profound impact on perioperative outcome. Beyond the immediate perioperative period, acute pain contributes to the development of the debilitating chronic pain syndrome. Going forward, both procedural and pharmacologic interventions for acute and chronic pain should be studied in definitive multicenter, well designed randomized clinical trials.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCerebral near-infrared spectroscopy in perioperative management of left ventricular assist device and extracorporeal membrane oxygenation patients.
Neurologic injury remains a common complication in patients undergoing mechanical support for cardiac and respiratory failure with either left ventricular assist devices (LVAD) or extracorporeal membrane oxygenation (ECMO). Cerebral near-infrared spectroscopy (NIRS) has been recognized clinically as a valid, continuous, and practical monitor of cerebral perfusion in cardiac surgery. Recently, interest in utilizing this technology to monitor patients while undergoing LVAD and ECMO placement and their resultant care has expanded. The purpose of this review is to discuss the practical approaches to using cerebral NIRS for LVAD and ECMO implantation. ⋯ Despite an overall small body of literature, early evidence suggests a possible beneficial effect of utilizing cerebral NIRS during LVAD and ECMO implantation. Prospective randomized studies are needed to develop algorithm-based therapies centered on NIRS monitoring. On the basis of potential benefits and minimal risks in relation to cerebral NIRS, it is recommended that it be utilized during the operative and immediate postoperative period in the LVAD and ECMO patient population.
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Chronic pain after surgery is a major public health problem and a major concern for perioperative physicians. Thoracic surgery presents a unique challenge, as thoracotomy is among the highest risk surgeries to develop persistent postsurgical pain. The purpose of this review is to discuss the relevance of research in pain epigenetics to patients with persistent pain after thoracic surgery. ⋯ The transition from acute to chronic pain after thoracic surgery may be mediated by epigenetics. Here, we discuss epigenetic modifications that have been discovered in animal models of chronic pain that may predispose patients to persistent neuropathic pain after thoracic surgery.
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Curr Opin Anaesthesiol · Feb 2014
ReviewSurgical and anesthetic considerations for the endovascular treatment of ruptured descending thoracic aortic aneurysms.
Ruptured descending thoracic aortic aneurysm (rDTAA) is a life-threatening disease. In the last decade, thoracic endovascular aortic repair (TEVAR) has evolved as a viable option and is now considered the preferred treatment for rDTAAs. New opportunities as well as new challenges are faced by both the surgeon and the anesthesiologist. This review describes the impact of current developments and new modalities for the surgical and anesthetic management of rDTAAs. ⋯ In order to improve outcomes of TEVAR for rDTAA, a close communication between the anesthesiologist and the surgeon and a thorough understanding of the events during the procedure is mandatory. The use of a proactive spinal cord protection protocol may decrease the rates of devastating spinal cord ischemia.