Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Feb 2016
ReviewAre morbidly obese patients suitable for ambulatory surgery?
The incidence of morbid obesity continues to increase worldwide. Associated comorbidities, particularly obstructive sleep apnea, increase the perioperative morbidity for this group of patients. The purpose of this review is to discuss appropriate selection of morbidly obese patients for ambulatory surgery. ⋯ Recent evidence suggests that carefully selected morbidly obese patients can safely undergo surgery on an ambulatory basis. Individualized evaluations taking into account patient-related factors, surgery-related factors, and anesthesia-related factors should dictate which patients are appropriate for ambulatory surgery.
-
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.
-
Curr Opin Anaesthesiol · Feb 2016
ReviewFast track in thoracic surgery and anaesthesia: update of concepts.
Update of key elements on enhanced recovery after thoracic anaesthesia and surgery. ⋯ The concept of enhanced recovery ('fast-track') after thoracic surgery and anaesthesia was developed in recent years making allowance to the increased number of video-assisted parenchymal lung resections in managing primary lung cancer. Current studies promote the benefit in thoracic surgical patients, if an established departmental protocol-based algorithm is implemented.
-
Cardiac surgery is associated with a wide range of microvascular derangements and with reduced tissue oxygenation. Although the macrohemodynamical targets during surgery may be achieved, the microcirculation may be damaged and remain dysfunctional. Direct observations of the microcirculation may enable more physiologically based approaches for diagnosis and treatment during cardiac surgery. ⋯ Direct visualization of the microcirculation using hand-held microscopy may provide the clinician the physiological feedback that is required for the early diagnosis and treatment of microcirculatory alterations during cardiac surgery. The coherence between the hemodynamic response of the macrocirculation and microcirculation during surgery seems to be essential.
-
Curr Opin Anaesthesiol · Feb 2016
ReviewTransthoracic echocardiography in the perioperative setting.
A need for further assessment of patients in the perioperative setting and an increasing availability of ultrasonography equipment have facilitated the diffusion of ultrasonography and lately focused transthoracic echocardiography (TTE) in anesthesiology practice. This review will discuss the possible use of focused TTE in the perioperative setting and provides an update on present and future perspectives. ⋯ Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.