Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2017
ReviewSpectrum of postoperative complications in pulmonary hypertension and obesity hypoventilation syndrome.
The purpose of this review is to identify chronic pulmonary conditions which may often not be recognized preoperatively especially before elective noncardiac surgery and which carry the highest risk of perioperative morbidity and mortality. ⋯ Pulmonary hypertension is a well recognized risk factor for postoperative complications after cardiac surgery but the literature surrounding noncardiac surgery is sparse. Pulmonary hypertension was only recently classified as an independent risk factor for postoperative complications in the American Heart Association/American College of Cardiology Foundation Practice Guideline for noncardiac surgery. Spinal anesthesia should be avoided in most surgeries on patients with pulmonary hypertension because of it's rapid sympatholytic effects. The presence of significant right ventricle dysfunction and marked hypoxemia should prompt re-evaluation of the need for elective surgery. Obesity hypoventilation syndrome is even harder to recognize preoperatively as arterial blood gases are generally not obtained prior to elective noncardiac surgery. Amongst patients with obstructive sleep apnea this group of patients carries much higher risk of postoperative respiratory and congestive heart failure.
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Curr Opin Anaesthesiol · Feb 2017
ReviewObesity hypoventilation syndrome, sleep apnea, overlap syndrome: perioperative management to prevent complications.
The prevalence of sleep disordered breathing (SDB) is increasing proportional to the prevalence of obesity. Although anesthesiologists are familiar with obstructive sleep apnea (OSA) - the most common SDB, anesthesiologists may not be aware of other SDB such as obesity hypoventilation syndrome (OHS) and overlap syndrome (combination of OSA and chronic obstructive pulmonary disease). The present review provides an update of information regarding the perioperative management of OHS and overlap syndrome. ⋯ Identification and preoperative optimization of these high-risk patients are most important. A protocol-based risk mitigation is necessary for improving the intraoperative and postoperative outcome of these patients. As a perioperative physician, anesthesiologists have a key role in the management of patients with SDB.
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Curr Opin Anaesthesiol · Feb 2017
ReviewPrevention of cardiac surgery-associated acute kidney injury.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequently occurring complication. It carries the risks of increasing mortality and development of chronic kidney disease. The complex pathophysiologic mechanisms still remain unexplained to a large extent. As a result, there is a considerable lack of sufficient therapeutic strategies with renal replacement therapy still representing the cornerstone for the treatment of severe AKI. ⋯ The identification of high-risk patients for AKI and the adherence to the Kidney Disease: Improving Global Outcomes guidelines constitute the mainstays in the management of CSA-AKI. It is of paramount importance to always maintain a sufficient perfusion pressure throughout the perioperative period. In patients at high risk, the use of new biomarkers and remote ischemic preconditioning should be considered.
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The applications for extracorporeal membrane oxygenation for lung support are constantly evolving. This review highlights fundamental concepts in extracorporeal lung support and describes directions for future research. ⋯ Extracorporeal lung support is a safe and an easily implemented intervention for refractory respiratory failure. Recent advances have extended its use beyond acute illnesses and the developments for chronic support will facilitate the development of durable devices and possible artificial lung development.
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Curr Opin Anaesthesiol · Feb 2017
ReviewDoes fluid management affect the occurrence of acute kidney injury?
To describe the potential impact of different fluid management strategies on renal outcomes in critically ill and postoperative patients. ⋯ Although synthetic colloids should be avoided in patients with or at risk of AKI, the renal efficacy of using albumin solutions and/or balanced crystalloids as alternatives to 0.9% sodium chloride in high-risk patients is yet to be confirmed or refuted. Improved goal-directed protocols, which minimize unnecessary fluid administration and reduce potentially harmful effects of fluid overload, need to be developed and tested.