Current opinion in anaesthesiology
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To describe the epidemiology, pathophysiology, diagnosis and management of perioperative acute kidney injury (AKI) in elderly patients. ⋯ Postoperative AKI incidence is expected to rise as the number of elderly patients undergoing surgery is increasing. Biomarkers of early AKI will likely be important for the future development and validation of novel treatment strategies. The haemodynamic management of the elderly surgical patient should focus on avoiding hypotension and high central venous pressures.
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To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage. ⋯ Targeted hemostatic therapy aims to correct coagulopathies in specific clinical settings, and reduce the need for allogeneic transfusions, thus preventing massive transfusion and its deleterious outcomes. Although there are specific guidelines for reversing anticoagulation in patients treated with antiplatelet agents or warfarin, there is currently little evidence to advocate comprehensive recommendations to treat drug-induced coagulopathy associated with new oral anticoagulants.
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The aim of the present review was to describe recent changes in blood banking thinking, practice, and products that affect trauma care. ⋯ Early initiation of balanced massive transfusion protocols leading to hemostatic resuscitation is lifesaving. Changing blood product availability and composition will lead to higher complexity of massive transfusion. It is critical that anesthesiologists understand the composition of the available new blood products to use them correctly.
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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.