Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2017
ReviewTiming of postoperative respiratory emergencies: when do they really occur?
Opioid-induced postoperative respiratory depression has garnered attention and calls for vigilance. However, a higher level of monitoring equates to increased use of hospital resources and is impractical to apply for all postoperative patients. Understanding the temporal pattern of postoperative respiratory emergency occurrences would allow for improved triage of monitoring resources for high-risk patients. Our objective is to describe the temporal pattern of risk of postoperative opioid-induced respiratory failure. ⋯ Emerging evidence indicates that the first postsurgical day carries the highest risk of adverse respiratory events, and this risk is often associated with opioid administration. Resources for increased monitoring should be directed to these high-risk times.
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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.
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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
ReviewSleep, sleep studies and sleep-disordered breathing: basic knowledge for the anesthesiologist.
To provide a basic understanding of sleep physiology, the pathophysiology of sleep-disordered breathing and the processes applied in undertaking and assessing sleep studies. ⋯ This review describes the physiology of sleep including sleep stages, sleep monitoring, the normal hypnogram and investigation from simple overnight pulse oximetry to full polysomnography. The pathophysiology of sleep-disordered breathing is discussed; from simple snoring through obstructive sleep apnoea to obesity hypoventilation syndrome. The relationship to metabolic syndrome is explored.Salient points in the interpretation of sleep study reports are presented.
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This article reviews the technology and clinical data describing hemodynamic monitoring devices available to anesthesiologists and intensivists caring for patients undergoing thoracic surgical procedures, so that they may better utilize available technology to improve outcomes in this high-risk surgical population. ⋯ Technology that has been shown to improve clinical outcomes in major surgical procedures is likely applicable to patients undergoing thoracic surgical procedures; however, several unique features of these procedures limit or modify the way in which these devices can be used. Understanding the scientific basis of these devices is the key to using them effectively.