Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2016
ReviewLung transplantation: from the procedure to managing patients with lung transplantation.
The perioperative management of lung transplantation patients remains a challenge. The most important goal is the prevention or attenuation of primary graft failure due to ischemia and reperfusion, operative trauma, and activation of systemic inflammation; it significantly influences short-long and long-term outcome. This review focuses on different aspects regarding the management of these high-risk patients. ⋯ There is evidence that important key strategies improve outcome after lung transplantation. An update on the substantial challenges in anesthesia comprises ventilator strategy and the use of extracorporeal circulation to minimize inflammation associated with primary graft failure.
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Curr Opin Anaesthesiol · Feb 2016
ReviewPearls and pitfalls in managing right heart failure in cardiac surgery.
To review the recent insights in the evaluation and management of perioperative (RHF). ⋯ An integrated approach for assessing the cardiopulmonary axis combining imaging, hemodynamic and tissue perfusion monitoring is emerging, as particularly helpful in the field. Several developments in the field of temporary right heart support including the pumpless interventional lung assist membrane ventilator are offering new opportunities to support the right-heart pulmonary circulation. Future multicenter studies are needed to develop more effective preventive and therapeutic strategies for RHF.
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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 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.