Current opinion in anaesthesiology
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The present review highlights recent findings on perioperative systolic heart failure. It briefly summarizes the pathophysiology of heart failure and provides the reader with new insight in diagnosis and treatment of systolic heart failure. In addition, we review new therapeutic strategies with pharmacologic agents and mechanical assist devices to treat systolic heart failure. ⋯ Recent advances in the field of cardiovascular anesthesiology comprise advanced use of perioperative echocardiography, mechanical circulatory assist devices, and customized pharmacologic management.
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Curr Opin Anaesthesiol · Feb 2016
ReviewAcute respiratory distress syndrome following cardiovascular surgery: current concepts and novel therapeutic approaches.
This review gives an update on current treatment options and novel concepts on the prevention and treatment of the acute respiratory distress syndrome (ARDS) in cardiovascular surgery patients. ⋯ Preventing ARDS as a severe complication in the cardiovascular surgery setting may help to reduce morbidity and mortality. As cardiovascular surgery patients are of greater risk to develop ARDS, preventive interventions should be implemented early on. Especially, use of low tidal volumes, avoiding of fluid overload and restrictive blood transfusion regimes may help to prevent ARDS.
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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.
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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.