Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2016
ReviewDoes major surgery induce immune suppression and increase the risk of postoperative infection?
Infection is the commonest cause of a postoperative complication. Following major surgery alterations in immune function are commonplace and these may contribute to an enhanced susceptibility to acquire nosocomial infections. This review will discuss postoperative infections in the context of an altered perioperative immune response and the factors influencing this response. ⋯ Point of care tests are emerging that allow monitoring of the perioperative immune response. These could be further developed to introduce personalised care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that may be associated with poor outcomes through immune modulation.
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Obstetric anesthesiologists are supposed to understand the uterotonics and tocolytics used in the perinatal period to provide a better clinical practice. This review describes current consensus of uterotonics and tocolytics used in the perinatal period that an obstetric anesthesiologist should know. ⋯ Anesthesiologists involved in obstetric anesthesia should be able to determine the appropriate uterotonic for cesarean section and know the indication of tocolytics in perinatal period.
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Curr Opin Anaesthesiol · Jun 2016
ReviewThe impact of glycaemic variability on the surgical patient.
Diabetes is the most prevalent long-term metabolic condition and its incidence continues to increase unabated. Patients with diabetes are overrepresented in the surgical population. It has been well recognized that poor perioperative diabetes control is associated with poor surgical outcomes. The outcomes are worst for those people who were not recognized as having hyperglycaemia. ⋯ glycaemic control remains an important consideration in the surgical patient.
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Anemia remains a global health issue. This review addresses the recent findings on anemia in surgical patients and its significance in perioperative setting. ⋯ Active screening for anemia and proper management of it in perioperative setting is essential. Several strategies to prevent anemia - including elimination of unnecessary diagnostic blood draws - are effective and reasonable approaches.
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Curr Opin Anaesthesiol · Jun 2016
ReviewPerioperative considerations in children with autism spectrum disorder.
Children with autism often present a challenge to the anesthesiologist. This review summarizes the current experiences and recommendations for the perioperative management of this unique group of patients. ⋯ Patients with autism spectrum disorder are a heterogeneous group and often need general anesthesia for different procedures and studies. Familiarity with each patient's behavioral specifics and efforts to alleviate stress is of paramount importance for a smooth perioperative course with minimal adverse events.