Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2023
ReviewPostoperative nausea and vomiting: risk factors, prediction tools, and algorithms.
Postoperative/postdischarge nausea and vomiting (PONV/PDNV) remain relevant issues in perioperative care. Especially in ambulatory surgery, PONV can prevent discharge or lead to unplanned readmission. ⋯ PDNV management is based primarily on consequent prophylaxis and therapy of PONV.
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Curr Opin Anaesthesiol · Feb 2023
ReviewTrends in outcomes of pregnancy in patients with congenital heart disease.
This review aims to analyze the trends in the management of pregnant patients with congenital heart disease (CHD). ⋯ The findings that this article summarizes have profound implications for clinical practice and management of the patient with CHD, including the optimization of preoperative screening, facilitation of ideal prenatal care to include qualified specialists and resources, and recommendations for optimal anesthetic management during labor and delivery.
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Curr Opin Anaesthesiol · Feb 2023
ReviewHow, when and why to establish preoperative surgical risk in thoracic surgery.
Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of comorbidities that may complicate thoracic procedures, and references recent best practices for their management. ⋯ Optimizing patients for thoracic surgery can be challenging for small and large health systems alike. Implementation of evidence-based guidelines can improve care and mitigate risk. As surgical techniques evolve, future research is needed to ensure that perioperative care continues to progress.
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Curr Opin Anaesthesiol · Feb 2023
ReviewMultimodal prehabilitation program valuation for thoracic surgical patients.
Modifiable patient-related risk factors, such as physical, emotional, and cognitive frailty, poor nutritional status, sleep hygiene, anemia, alcohol abuse, and smoking reduce a patient's ability to effectively recover from the insult of surgery. Herein, we review the value of implementing a comprehensive prehabilitation program for patients undergoing thoracic surgery. ⋯ It stands to reason that well designed prehabilitation programs can add value by improving quality metrics at a lower cost to our healthcare system. Definitive randomized trials are needed to confirm this notion.
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Curr Opin Anaesthesiol · Feb 2023
ReviewMitochondrial transplantation in cardiac surgical patients: optimism, caveats, and outstanding questions.
Mitochondria satisfy the high metabolic demand of the heart, and also play major roles in reactive oxygen species signaling, calcium buffering, and regulation of cell death. Mitochondrial damage or dysfunction can drive diseases seen in cardiac surgical patients, including heart failure and ischemia/reperfusion injury. Exogenous transplantation of isolated mitochondria has been proposed as one way to augment mitochondrial function and mitigate a number of pathologic processes, with a heavy focus on ischemia/reperfusion injury. ⋯ Mitochondrial transplantation is a potential therapeutic strategy for cardiac ischemia/reperfusion injury. Effective application to selected cardiac surgical patients can be informed by further mechanistic investigations.