Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2021
ReviewRegional anaesthesia in the elderly patient a current perspective.
The world's population is ageing. Although regional anaesthesia is well established, it seems there is limited evidence to support its use over general anaesthesia in the elderly. This review aims to examine recent publications of regional anaesthesia in relation to this specific patient subgroup. ⋯ Undoubtedly, peripheral nerve blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand these side effects. Future large prospective trials are required to evaluate the duration of action and safety profile of local anaesthetic agents and adjunct agents in the older patient.
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Curr Opin Anaesthesiol · Feb 2021
ReviewPrevent deterioration and long-term ventilation: intensive care following thoracic surgery.
Patients with indication for lung surgery besides the pulmonary pathology often suffer from independent comorbidities affecting several other organ systems. Preventing patients from harmful complications due to decompensation of underlying organ insufficiencies perioperatively is pivotal. This review draws attention to the peri- and postoperative responsibility of the anaesthetist and intensivist to prevent patients undergoing lung surgery deterioration. ⋯ A perioperative interprofessional approach and a change in paradigms are the prerequisites to improve outcome and provide treatment for elder and comorbid patients with an indication for thoracic surgery.
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Curr Opin Anaesthesiol · Feb 2021
ReviewTransesophageal echocardiography for perioperative management in thoracic surgery.
Perioperative transesophageal echocardiography (TEE) is most often employed during cardiac surgery. This review will summarize some of the recent findings relevant to TEE utilization during thoracic surgical procedures. ⋯ Currently, routine use of TEE in thoracic surgery is often limited to specific high-risk patients and/or procedures. As in other perioperative settings, TEE may be utilized to elucidate the reasons for acute hemodynamic instability without apparent cause. Contraindications to TEE apply and have to be taken into consideration before performing a TEE on a thoracic surgical patient.
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Curr Opin Anaesthesiol · Feb 2021
ReviewTo tube or not to tube: a skeptic's guide to nonintubated thoracic surgery.
The aim of this review is to provide an overview of the rationale and evidence for nonintubated thoracic surgery and guide clinicians, considering the implementation of nonintubated thoracic surgery, to find an anesthetic approach suitable for their department. ⋯ In select patients and with experienced teams, nonintubated thoracic surgery can be a suitable alternative to intubated thoracic surgery. Until more evidence is available, however, a general change in anesthetic management in thoracic surgery is not justified.
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Curr Opin Anaesthesiol · Feb 2021
ReviewMinimizing postoperative pulmonary complications in thoracic surgery patients.
Quantification and optimization of perioperative risk factors focusing on anesthesia-related strategies to reduce postoperative pulmonary complications (PPCs) after lung and esophageal surgery. ⋯ The main anesthesiological strategies to reduce PPCs after thoracic surgery include the use of epidural anesthesia, lung-protective ventilation: PEEP (positive end-expiratory pressure) of 5-8 mbar, tidal volume of 5 ml/kg BW (body weight) and goal-directed hemodynamics: CI (cardiac index) ≥ 2.5 l/min per m2, MAD (Mean arterial pressure) ≥ 70 mmHg, SVV (stroke volume variation) < 10% with a total amount of perioperative crystalloid fluids ≤ 6 ml/kg BW (body weight) per hour.