Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2019
ReviewRole of anesthesiologists in managing perioperative anemia.
Anemia can contribute negatively to a patient's morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings. ⋯ Within the previous 18 months, important publications have demonstrated the established role of anesthesiologists in managing perioperative anemia. A substantial pillar for anemia treatment is the implementation of Patient Blood Management worldwide.
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Curr Opin Anaesthesiol · Feb 2019
ReviewIncremental value of noncerebral somatic tissue oxygenation monitoring for patients undergoing surgery.
There is increasing interest in the use of noncerebral somatic tissue oxygen saturation (SstO2) monitoring on the basis of near-infrared spectroscopy in patients undergoing surgery or residing in intensive care unit. The relevant question is whether SstO2 monitoring can improve the quality of care. In this article, we reviewed the clinical application of SstO2 monitoring in acute care, focusing on its use in patients undergoing surgery. ⋯ Somatic tissue oxygenation may represent an essential aspect of human physiology in acute care, and it is likely outcome-relevant based on observational cohort studies. Future research should examine whether SstO2-guided care can further improve patient outcomes using randomized controlled trials.
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Curr Opin Anaesthesiol · Feb 2019
ReviewSpinal cord perfusion protection for thoraco-abdominal aortic aneurysm surgery.
Spinal cord ischemia (SCI) is a devastating complication after open or endovascular aortic repair for thoracoabdominal aortic disease. The underlying pathogenesis is not fully understood but appears multifactorial. Multiple spinal cord protection strategies and monitoring techniques are currently utilized with variable results seen. The purpose of this review is to summarize important and recent findings related to cause, monitoring and impact of multiple spinal cord protection strategies. ⋯ SCI leading to paraplegia is a multifactorial complication that remains a major concern in complex aortic surgeries. Although there are no sufficient data to document the efficacy of spinal cord protection techniques individually, their effect on lowering the risk of SCI is most evident when used concomitantly using a multimodal approach that encompasses the perioperative and early postoperative period.
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With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. ⋯ Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given.
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Curr Opin Anaesthesiol · Feb 2019
ReviewExamination of the enhanced recovery guidelines in thoracic surgery.
Enhanced Recovery After Thoracic Surgery (ERATS) has gained momentum over the past few years, although the evidence base and expert recommendations lag behind other specialties. This review will present and examine key points from the first guidelines for enhanced recovery after lung surgery, released in 2018, jointly sponsored by the European Society of Thoracic Surgeons and the Enhanced Recovery After Surgery Society. ⋯ The creation of guidelines for enhanced recovery after lung resection will provide the thoracic anesthesiologist a framework upon which to build a comprehensive perioperative anesthetic plan.