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
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.