Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2017
ReviewPreoperative evaluation and preparation of the morbidly obese patient.
This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. ⋯ Synthesis of proper medical history-taking and physical examination as well as detailed search for obstructive sleep apnea and metabolic syndrome are key components of preoperative evaluation. Further testing should be based on the findings of these steps and comprise the cardiac risk of the surgical procedure.
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The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) continues to increase and is associated with significant morbidity and mortality. Early diagnosis and identification of patients at risk are extremely important. Therefore, identifying associated risk factors, biomarkers for earlier detection, prevention and therapeutic options for CS-AKI warrant special attention. ⋯ It is extremely important to identify those who are at increased risk for CS-AKI with the foremost goal being that of prevention to help decrease morbidity and mortality. Combining functional and tubular biomarkers can assist with early identification. Once identified, early interventions including avoidance of nephrotoxins, decreasing cardiopulmonary bypass time, avoiding fluid overload and early initiation of renal replacement therapy may lead to improved clinical outcomes.
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Curr Opin Anaesthesiol · Feb 2017
ReviewTherapy of acute kidney injury in the perioperative setting.
The current review analyzes the current pharmacologic approaches in cardiac surgery-associated acute kidney injury and renal replacement/support therapies. ⋯ Cardiac surgery is responsible for the highest risk of renal dysfunction with respect to other surgical settings. A number of different and coacting insults, including toxins, renal hypoperfusion, ischemia-reperfusion injury, and systemic inflammation, are leading causes of this frequent complication. Intense research is ongoing on the treatment of established cardiac surgery-associated acute kidney injury and, in this view, a holistic approach including preoperative data, risk stratification, prevention, timely diagnosis, and aggressive intervention can limit the burdening consequences of renal dysfunction in these patients. Although no specific pharmacologic and nonpharmacologic strategy can be currently recommended outside clinical research, the prompt identification of renal dysfunction and the application of multimodal treatments are fundamental aspects. Right ventricular dysfunction and increased central venous pressure, frequently affecting cardiac surgery patients, potentially lead to congestive renal dysfunction. Hemodynamic management covers a central role in these cases.
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Curr Opin Anaesthesiol · Feb 2017
ReviewSingle-lung ventilation and oxidative stress: a different perspective on a common practice.
To summarize what is currently known about the relationship between single-lung ventilation (SLV), oxidative stress, and postoperative disruption of organ function. ⋯ SLV and subsequent re-expansion of atelectatic lung are associated with the generation of reactive oxygen and nitrogen species that may modulate persistent systemic effects.