Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Feb 2022
Review Meta AnalysisProthrombin complex concentrates in cardiac surgery: where are we?
Major bleeding in cardiac surgery is commonly encountered, and, until recently, most frequently managed with fresh frozen plasma (FFP). However, a Cochrane review found this practice to be associated with a significant increase in red blood cell (RBC) transfusions and costs. These findings have led to off-label uses of prothrombin complex concentrates (PCCs) in cardiac surgery. The purpose of this review is to compare and contrast the use of FFP and PCC, review the components, limitations and risks of different types of PCCs, and discuss the latest evidence for the use of PCC versus FFP in cardiac surgery. ⋯ The current data supports the use of 4F-PCC instead of FFP as the primary hemostatic agent in cases of major bleeding in cardiac surgery. The use of PCCs is associated with reduced rates of RBC transfusions while maintaining a favorable safety profile. Clear advantages of PCC over FFP include its smaller volume, higher concentration of coagulation factors and shorter acquisition and administration times.
-
Curr Opin Anaesthesiol · Feb 2022
ReviewAnesthesia for tracheal and carinal resection and reconstruction.
The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction. ⋯ The spectrum of available anesthetic techniques for major airway surgery is immense. To find the safest approach for the individual patient, comprehensive interdisciplinary planning is essential. The location and anatomic consistency of the stenosis, comorbidities, the functional status of respiratory system, as well as the planned reconstructive technique need to be considered. Until more data is available, however, a reliable evidence-based comparison of different approaches is not possible.
-
Curr Opin Anaesthesiol · Feb 2022
ReviewDonation after cardiac death in heart transplantation: is there an ethical dilemma?
In an attempt to address the organ shortages in heart transplantation, USA centres have begun utilizing donation after cardiac death (DCD) as an alternative to traditional donation after brain death (DBD). As this paradigm continues to expand, there is a need to address the medico-legal and ethical aspects of DCD donation, which is the focus of the current review. ⋯ In the current article, we review the ethical issues raised with DCD and define DCD protocols and their ability to comply with established regulatory guidelines while respecting the wishes of patients and their surrogates through informed decisions making about organ donation and end-of-life care.
-
Curr Opin Anaesthesiol · Feb 2022
ReviewHow to train thoracic anesthesia for residents and consultants?
The training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied. In this review, we will show how professional curricula should aim for competence rather than number of cases and why simulation-based training and debriefing should be implemented. ⋯ Interdisciplinary and interprofessional learning can take place in simulation trainings and on a daily basis through postevent debriefings. When these debriefings are conducted in a structured way, an improvement in the performance of the entire team can be the result. The basis for these debriefings - as well as for other training approaches - is psychological safety, which should be established and maintained together with all professions involved.
-
Curr Opin Anaesthesiol · Feb 2022
ReviewPreoperative evaluation in thoracic surgery: limits of the patient's functional operability and consequence for perioperative anaesthesiologic management.
Preoperative evaluation of older and more morbid patients in thoracic surgery is getting more advanced. In this context, early risk stratification has a crucial role for adequate informed decision-making, and thus for generating favourable effects of clinical outcome. ⋯ A comprehensive risk stratification by anaesthesiologists generates valuable guidance for the best strategy of clinical treatment. This includes preoperative, peri-operative and postoperative interventions, provided by interdisciplinary healthcare providers, resulting in an Early Risk Stratification and Strategy ('ERSAS') pathway.