Current opinion in anaesthesiology
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Chronic kidney disease (CKD) is an increasing health problem worldwide and is associated with a number of clinical challenges. In this paper, we review recent studies that deal with strategies for the management of patients with CKD undergoing surgery. ⋯ Identification and risk stratification is crucial for the perioperative management of patients with CKD. To improve clinical outcomes, nonemergent procedures should be postponed, renal function optimized, nephrotoxic drugs avoided, and AKI prevented.
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Curr Opin Anaesthesiol · Jun 2016
ReviewMyocardial injury after noncardiac surgery: an underappreciated problem and current challenges.
To review myocardial injury after noncardiac surgery (MINS), focusing on recent studies, including data on high-sensitivity troponin, which is likely to alter our understanding of MINS. ⋯ Currently, we are limited to appreciating the vast extent of the MINS problem and applying recommendations based on observational data or derived from the nonoperative setting. Routine troponin measurements after noncardiac surgery and the increasing use of high-sensitivity troponins have revealed the larger underwater iceberg of perioperative myocardial injury and ischemia. Clinicians should be sensitized for this important complication and search for it using a perioperative troponin screening.
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Congestive heart failure (CHF) is one of the most common diseases of the elderly patient. The underlying pathophysiology varies considerably and approximately 50% of the patients suffer from CHF with reduced left ventricular ejection fraction. Mortality in the perioperative period is increased in patients with CHF and this holds true for both minor and major surgeries. This review will summarize recent literature in the field of CHF and perioperative outcome in patients undergoing surgery with a special emphasis on actual guidelines, preoperative assessment and appropriate perioperative therapy. ⋯ CHF is a source of considerable perioperative morbidity and mortality and in contrast to coronary artery disease, knowledge is very limited and additional research urgently needed.
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This article provides the reader with recent findings on the pathophysiology of comorbidities in the obese, as well as evidence-based treatment options to deal with perioperative respiratory challenges. ⋯ Anesthesia of obese patients for nonbariatric surgical procedures requires knowledge of typical comorbidities and their respective treatment options. Apart from cardiovascular diseases associated with the metabolic syndrome, awareness of any pulmonary dysfunction is of paramount. A multimodal analgesia approach may be useful to reduce postoperative pulmonary complications.
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This review outlines the challenges in looking after pregnant women with thromboembolism and sepsis who either become or are at risk of becoming critically ill during pregnancy. ⋯ In this review, we discuss the pathophysiology, diagnosis, and management of thromboembolism and sepsis, two very important conditions with high mortality requiring admission to intensive care.