Current opinion in anaesthesiology
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The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. ⋯ The information in this article is by no means comprehensive. Nongeriatric trauma protocols are far from being validated. Applying these protocols to the geriatric protocols must be investigated in terms of safety and benefits.
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We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. ⋯ Sleep disturbances are common in patients after surgery and produce harmful effects on postoperative recovery. Sleep-promotion therapy may be helpful to improve postoperative recovery, but long-term effects deserve further study.
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Curr Opin Anaesthesiol · Feb 2018
ReviewDrug-induced sleep endoscopy: from obscure technique to diagnostic tool for assessment of obstructive sleep apnea for surgical interventions.
Provide a practical update on drug-induced sleep endoscopy (DISE) for anesthesia providers, which can also serve as a reference for those preparing to establish a DISE program. ⋯ The role of DISE in surgical evaluation and planning for treatment of OSA continues to develop. Numerous questions as to the optimal anesthetic approach remain unanswered. Multicenter studies that employ a standardized approach using EEG assessment, pharmacokinetic-pharmacodynamic modelling, and objectively defined clinical endpoints will be helpful. There may be benefit to undertaking DISE studies in non-OSA patients.
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Review of historical and current evidence of adrenal suppression in patients on chronic glucocorticoid therapy during perioperative period, and discussion of current recommendations for perioperative stress dose steroid administration. ⋯ Current recommendations for perioperative stress dose steroids for patients on chronic glucocorticoid therapy are based on duration and dose of maintenance steroids. All patients should take their regular daily dose of steroid preoperatively regardless of dose or chronicity of prior treatment. Additional, stress dose steroid dosing is based on patient risk of adrenal suppression and surgical complexity and stress.
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This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly. ⋯ Anesthetic dosing should be more closely age-adjusted to prevent anesthetic-induced hypotension and increased depth of anesthesia in the elderly. Pharmacologic studies are required in the elderly population (>80 years).