Current opinion in anaesthesiology
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A large proportion of patients undergoing surgery have coexisting chronic kidney disease, placing them at greater risk of postoperative morbidity and mortality. The purpose of this review is to review the recent developments in how renal function is estimated, how this relates to surgical outcomes, and how this has been applied clinically. ⋯ Improved accuracy in defining kidney disease will aid clinicians in identifying higher risk patients, and aid earlier diagnosis of acute kidney injury. Further research is required, specifically on the implications of kidney disease in noncardiac surgical patients, and how defining renal function before and after surgery can aid in preventive strategies.
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Curr Opin Anaesthesiol · Apr 2014
ReviewThe changing anesthesia economic landscape: emergence of large multispecialty practices and Accountable Care Organizations.
In this review, we evaluate the current US employment models for healthcare in general and anesthesiologists in particular and the emergence of large, multispecialty physician groups and the forces behind this change to the current anesthesia practice model. We will also examine the present payment method for anesthesiologists and determine how Accountable Care Organizations will affect the future payment models. ⋯ This is the most critical time in the specialty of anesthesiology from an economic viewpoint, and significant threats and opportunities will arise for anesthesiologists in how they are reimbursed, and how they demonstrate the delivery of quality care to patients.
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The purpose of this review is to highlight the use of tranexamic acid, point-of-care testing, algorithm-based treatment of trauma-associated coagulopathy with factor concentrates to reduce blood loss and transfusion requirements in order to improve outcome. In addition, the management of patients on new oral anticoagulants, drugs with renewed interest and the tolerance of relatively low hemoglobin levels in the context of trauma will be discussed. ⋯ Applying Patient Blood Management concept to the trauma patient is possible and efficacious. Antihyperfibrinolytics such as tranexamic acid, point-of-care testing and coagulation algorithms with the use of factor concentrates allow a reduction of the number of transfusions, the costs and will likely ameliorate outcome of major trauma patients.
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Curr Opin Anaesthesiol · Apr 2014
ReviewPreventing and managing perioperative pulmonary complications following cardiac surgery.
To provide an update of research findings on the mechanisms underlying respiratory complications after cardiac surgery, especially acute respiratory distress syndrome, transfusion-related lung injury and ventilation-associated pneumonia. The article will review some of the preventive and therapeutic measures that can be implemented to reduce these complications, focusing on the use of protective invasive ventilation and postextubation noninvasive ventilation. ⋯ Postoperative pulmonary complications are common, but severe complications are infrequent. Their reduction requires measures to prevent infection and mechanical ventilation-associated lung injury through the use of low tidal volumes and early extubation. Noninvasive ventilation after extubation can be utilized to avoid reintubation and the associated increased morbidity and mortality. However, noninvasive ventilation should be done under rigorous conditions and by following strict criteria.
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Curr Opin Anaesthesiol · Apr 2014
Review Comparative StudyCost-efficiency of knowledge creation: randomized controlled trials vs. observational studies.
This article reviews traditional and current perspectives on randomized, controlled trials (RCTs) and observational studies relative to the economic implications for public healthcare stakeholders. ⋯ Considering the strengths and limitations of each study type, clinical researchers should explore the contextual worthiness of either design in promulgating knowledge. They should focus on quality of conduct and reporting that may allow for the liberation of limited public and private clinical research funding.