Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2019
ReviewExtravascular lung water monitoring for thoracic and lung transplant surgeries.
Excessive accumulation of extravascular lung water (EVLW) resulting in pulmonary edema is the most feared complication following thoracic surgery and lung transplant. ICUs have long relied on chest radiography to monitor pulmonary status postoperatively but the increasing recognition of the limitations of bedside plain films has fueled development of newer technologies, which offer earlier detection, quantitative assessments, and can aide in preoperative screening of surgical candidates. In this review, we focus on the emergence of transpulmonary thermodilution (TPTD) and lung ultrasound with a focus on the clinical integration of these modalities into current intraoperative and critical care practices. ⋯ Monitoring EVLW in the perioperative period offers clinicians a powerful tool to guide fluid therapy and manage pulmonary edema. Both TPTD and lung ultrasound have unique attributes in the care of thoracic surgery and lung transplant patients.
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Curr Opin Anaesthesiol · Feb 2019
ReviewDelayed recovery following thoracic surgery: persistent issues and potential interventions.
Lung and esophageal surgery remain a curative option for resectable cancers. However, despite advances in surgical and anesthesia practices, the inclusion of patients with comorbidities that would have previously not been offered curative resection presents additional concerns and challenges. ⋯ Delayed and complicated recovery after thoracic noncardiac surgery persist in current practice. This review analyzes the diverse factors that can impact complications and quality of life after lung surgery and the interventions that can help decrease length of stay and improve return to baseline conditions.
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Curr Opin Anaesthesiol · Dec 2018
ReviewBest perioperative practice in management of ambulatory patients with obstructive sleep apnea.
Obstructive sleep apnoea patients receiving opioids should have post-operative continuous monitoring.
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