Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2015
ReviewResidents' scholarly activity: a cost analysis with regard to its effects on departments.
Current financial strain on training departments may have a significantly negative impact on continuing support for residents' scholarly activity. A cost analysis with regard to residents' scholarly activity effects on anesthesiology training departments is performed. ⋯ The importance of resident scholarly activity has never been so or as critical as in the present. Anesthesiology leadership must continue to invest to support resident scholarly activity for the future of the specialty while being mindful of costs incurred.
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Curr Opin Anaesthesiol · Apr 2015
ReviewRemote ischemic preconditioning and outcome: shall we all have an intermittent tourniquet?
Although advancements in perioperative care have been made over the last decades, the perioperative outcome could not be improved adequately. Therefore, new therapeutic strategies are required to decrease morbidity and all-cause mortality in surgical patients. Remote ischemic preconditioning (RIPC), defined as brief and transient episodes of ischemia at a remote site before a subsequent injury of the target organ, is an adaptive response to protect for organ injury elicited by different stimuli. This review evaluates the current clinical evidence for RIPC as a potential tissue-protective strategy and discusses the underlying mechanism. ⋯ RIPC may offer a novel inexpensive and noninvasive therapeutic strategy to alleviate organ injury in the perioperative period. However, adequately powered, large, multicenter clinical studies are necessary to accurately determine whether ischemic conditioning can improve the clinical outcomes of patients at risk for ischemia-reperfusion injury.
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Sepsis, defined by the presence of infection and host inflammation, is a lethal clinical syndrome with an increasing mortality rate worldwide. In severe disease, the coagulation system becomes diffusely activated, with consumption of multiple clotting factors resulting in disseminated intravascular coagulation (DIC). When present, DIC portends a higher mortality rate. Understanding the mechanisms that tie inflammation and diffuse thrombosis will allow therapeutic interventions to be developed. The coagulopathy of acute sepsis is a dynamic process that is time and disease burden specific. Whole-blood testing of coagulation may provide more clinically useful information than the classical tests. Natural anticoagulants that regulate thrombosis are downregulated in sepsis. Patients may benefit from the modulation of the coagulation system when systemic inflammation and hypercoagulopathy exist. Proper timing of anticoagulant therapy may ultimately lead to decreased incidence of multisystem organ dysfunction. ⋯ The prevention of DIC in septic patients is a key therapeutic target in preventing death from multisystem organ failure. Stratifying patients for therapy using thromboelastometry, specific markers for DIC, and composite scoring systems is an area of growing research.
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Curr Opin Anaesthesiol · Apr 2015
ReviewTopical hemostatic agents and dressings in the prehospital setting.
Death from exsanguinating hemorrhage remains a priority in the management of combat casualties and civilian trauma patients with truncal and junctional injuries. Appropriate use of hemostatic agents and dressings in the prehospital setting may allow for earlier control and an improved survival rate. ⋯ Efficacy of currently available hemostatic agents and dressings appears to have plateaued in recent years although new agents and delivery mechanisms under development may improve control in cases of severe hemorrhage.
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Curr Opin Anaesthesiol · Apr 2015
ReviewConsiderations for anesthesia staffing in a trauma center: new standards, education, and safety.
A review of recent updates to trauma anesthesia service requirements in the USA and UK, the evolving role of the trauma anesthesiologist, and opportunities for education and training. Considerations of cost and safety for staffing arrangements are discussed. ⋯ There is a growing recognition that trauma anesthesiology represents a distinct area of subspecialty knowledge. Anesthesiology specialty organizations advocate for trauma-specific knowledge and training for trauma anesthesia providers. Requiring the in-house presence of anesthesia providers in level I and level II trauma centers may impose significant costs on medical centers that do not currently provide those services.