Current opinion in anaesthesiology
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The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery. ⋯ Patients with liver disease undergoing anaesthesia pose significant challenges and advanced planning and preparation are required in order to improve perioperative outcomes in this group. VIDEO ABSTRACT: http://links.lww.com/COAN/A43.
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The current review considers an array of recent applications for point-of-care ultrasound in clinical practice including diagnostic and therapeutic procedures that may be relevant for the obstetric anesthesiologist. The rapid advancement of technology and clinical applications for bedside ultrasound in obstetric anesthesiology requires an appraisal of the limitations and uses. ⋯ Anesthesiologists have clearly embraced this facile versatile tool for bedside diagnostics and procedures. One limitation to widespread adoption is availability of suitable ultrasound skills and technology. Many of these ultrasound techniques have not yet established clear patient benefit, yet the sheer breadth of ultrasound techniques reported in the past few years demonstrate that our colleagues are becoming more proficient. It is important to follow the development of this emerging field to be aware of limitations to learning these skills and their potential clinical benefit. Proficiency in some of these point-of-care ultrasound techniques may become prerequisite for obstetric anesthesiologists to provide the best care.
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This review will deliberate on contemporary concepts regarding the frailty syndrome and its association with the perioperative period. Frailty syndrome and its relevance to organ systems, scoring tools and intervention measures will be discussed in detail. ⋯ Preoperative frailty is associated with significant morbidity and mortality. Recently, frailty assessment tools have been developed and show good ability to predict postoperative adverse events. These tools might become a preoperative routine, as they set the ground for patient's selection, guide perioperative interventions for the frail elderly population and thus may influence patient's outcome.
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As clinicians preparing patients for general anesthesia, should we consider the possibility of concussion in our elective operative patients? If so, why is this necessary? Is it possible that exposure to an anesthetic is detrimental to recovery from concussion? If so, what should we do about the imperative/urgency for surgery? No answers are promised in this review. Rather, the focus is on the questions and approaches taken in the recent literature, as well as highlighting a need for more research. ⋯ This review provides a perspective about autonomic nervous system function and cerebrovascular effects of concussion, and some relevant clinical issues that warrant further clinical study.