Current opinion in anaesthesiology
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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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Curr Opin Anaesthesiol · Jun 2016
ReviewDiagnosis and treatment of obstructive sleep apnea during pregnancy.
This review aims to provide an update on recent advances in the diagnosis and treatment of obstructive sleep apnea (OSA) during pregnancy and its effect on maternal and fetal outcomes. ⋯ Further research is needed to help in the detection and treatment of OSA in pregnancy.
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Curr Opin Anaesthesiol · Jun 2016
ReviewSurgical treatment of craniosynostosis in infants: open vs closed repair.
Correction of craniosynostosis may require extensive surgical interventions with related intra and postoperative complications especially hemorrhage. To reduce the intervention's impact and associated complications, less invasive surgical alternatives have evolved. The present review comprehensively summarizes surgical techniques, perioperative anesthesia management, success rates, complications, the results of outcome evaluations, and predictors of intra and postoperative complications. ⋯ Neuroendoscopic techniques, designed to minimize surgical incision, dissection, and blood loss, are becoming efficacious and valuable alternative therapeutic options reducing the need for fluid replacement and invasive hemodynamic monitoring. Since hemorrhage represents the most important complication in open craniosynostosis repair, prevention strategies such as the use of tranexamic acid should be considered. Sufficient correction of entailed coagulopathies is crucial.
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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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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.