Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2016
ReviewObstructive sleep apnea, pain, and opioids: is the riddle solved?
Perioperative opioid-based pain management of patients suffering from obstructive sleep apnea (OSA) may present challenges because of concerns over severe ventilatory compromise. The interaction between intermittent hypoxia, sleep fragmentation, pain, and opioid responses in OSA, is complex and warrants a special focus of perioperative outcomes research. ⋯ OSA may complicate opioid-based perioperative management of pain by altering both pain processing and sensitivity to opioid effect.
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This article reviews and summarizes the pathophysiology, risk factors, and the management of arrhythmias in patients undergoing noncardiac thoracic surgery. ⋯ Arrhythmias are common after thoracotomy. Physicians treating patients with postoperative arrhythmias should bear in mind that arrhythmia management does not only comprise a specific therapy for the arrhythmia itself, but also includes the correction of transient and correctable predisposing and causative factors.
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Curr Opin Anaesthesiol · Feb 2016
ReviewAnaesthesia for thymectomy in adult and juvenile myasthenic patients.
Myasthenia gravis, a chronic disease of the neuromuscular junction, is associated with an interaction with neuromuscular blocking agents (NMBAs). As thymectomy is often the method of choice for its treatment, anaesthetic management requires meticulous preoperative evaluation, careful monitoring, and adequate dose titration. The frequency of video-assisted thoracoscopic extended thymectomy (VATET) is also increasing, making the use of NMBA obligatory. The number of cases of the juvenile form has also increased over years; airway management in juvenile one-lung ventilation is another challenge. ⋯ Anaesthetic management of thymectomy in myasthenia gravis requires experience concerning different approaches. Sugammadex should be considered as a possible further step toward postoperative safety.
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Approximately 30% of the general surgical population presents with obesity, and the perioperative implications remain concerning. This review provides recent insights regarding morbid obesity and perioperative complications. ⋯ Further research and evidence are needed for the development of accepted perioperative pathways to address obesity and related comorbidities including sleep disordered breathing and metabolic syndrome as well as evidence-based strategies to reduce surgical infections. Rather than BMI alone, an improved index for obesity risk assessment is needed.
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Curr Opin Anaesthesiol · Feb 2016
ReviewEchophysiology: the transesophageal echo probe as a noninvasive Swan-Ganz catheter.
In an attempt to make cardiovascular monitoring less invasive and more effective, transesophageal echocardiography is progressively being used in critically ill patients suffering from hemodynamic instability. This review analyses the capacity of transesophageal echocardiography to fully replace the pulmonary artery catheter in the management of hemodynamic impairment, as transesophageal echocardiography similarly allows for the measurement of central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, stroke volume and cardiac output, and systemic vascular resistance. ⋯ Transesophageal echocardiography has the potential to offer a noninvasive, valid alternative to Swan-Ganz catheters in the hemodynamic assessment of patients in the perioperative period.