Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2018
ReviewAn update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea.
There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. ⋯ The prevalence of OSA in surgical patients is high. SASM has made recommendations in their published guidelines for the optimum preoperative preparation of patients with OSA. In the future, research may shift towards finding the underlying mechanism of OSA for targeted therapy.
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Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. ⋯ There is growing evidence from the literature that surgical resection is relatively safe in the elderly population. Age by itself should not preclude patients from having curative resection. Resections can be tailored to performance status of the patient.
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Curr Opin Anaesthesiol · Feb 2018
ReviewRisk factors for opioid-induced respiratory depression and failure to rescue: a review.
The primary objective of this review is to identify the risk factors for opioid-induced respiratory depression (OIRD) in the postoperative period. ⋯ Elderly, female sex, presence of obstructive sleep apnea, chronic obstructive pulmonary disease, cardiac disease, diabetes mellitus, hypertension, neurologic disease, renal disease, obesity, two or more comorbidities, opioid dependence, use of patient controlled analgesia, different routes of administration of opioids and concomitant administration of sedatives are significant risk factors for postoperative OIRD. The majority of patients with OIRD are deeply sedated and inadequately monitored. In patients with underlying risk factors, the dose of opioids should be carefully titrated. Enhanced monitoring of sedation level, respiratory rate, pulse oximetry and capnography is needed in the first 24 h after surgery.
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Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. ⋯ Elderly patients are suitable for enhanced recovery programmes but these must be tailored to individual circumstance. Further work is required to comprehensively assess their value in a modern healthcare setting.
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The extrinsic risk factors for postoperative cognitive disturbance have been a source of concern during the perioperative period, and these risk factors remain the subject of controversy. This review of recent studies focuses on the effect of these factors on postoperative cognitive disturbance during the perioperative period. ⋯ Several intraoperative factors are associated with postoperative cognitive disturbance. However, if these factors are optimized in perioperative management, postoperative cognitive disturbance will improve.