Current opinion in anaesthesiology
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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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This article focuses on the recent findings in the diagnosis and treatment of diastolic heart failure (DHF) or heart failure with preserved ejection fraction. ⋯ The understanding of the phenotypic heterogeneity and multifactorial pathophysiology of DHF may lead to novel therapeutic targets in the future. Currently, the key to the treatment of DHF is aggressive management of contributing factors.
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Curr Opin Anaesthesiol · Feb 2016
ReviewPerioperative opioids aggravate obstructive breathing in sleep apnea syndrome: mechanisms and alternative anesthesia strategies.
Opioids induce and increase the severity of most sleep-disordered breathing in all patients, but especially in morbidly obese patients. Discussed herein are the direct impact and mechanisms of opioids on inducing and exacerbating obstructive sleep apnea syndrome in normal and morbidly obese patients. ⋯ A multimodal nonopioid anesthesia method avoids the necessity for intraoperative opioids, reduces the need for postoperative opioid use, and improves analgesia with less narcotic.
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Curr Opin Anaesthesiol · Feb 2016
ReviewGoal-directed therapy in the operating room: is there any benefit?
This article reviews the current evidence behind goal-directed therapy (GDT) in multiple medical settings. ⋯ The use of GDT may be beneficial depending on the clinical setting, but more evidence supporting its use is necessary before it can be considered standard of care.
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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.