Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2022
Review Meta AnalysisSalted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension.
The aim of this review article is to present current recommendations regarding the use of hypertonic saline and mannitol for the treatment of intracranial hypertension. ⋯ Identifying and treating increased intracranial pressure is imperative in neurocritical care settings and proper management is essential to improve long-term outcomes. Currently, there is insufficient evidence from comparative studies to support a formal recommendation on the use of any specific hyperosmolar medication in patients with acute increased intracranial pressure.
-
Curr Opin Anaesthesiol · Feb 2022
Review Meta AnalysisProthrombin complex concentrates in cardiac surgery: where are we?
Major bleeding in cardiac surgery is commonly encountered, and, until recently, most frequently managed with fresh frozen plasma (FFP). However, a Cochrane review found this practice to be associated with a significant increase in red blood cell (RBC) transfusions and costs. These findings have led to off-label uses of prothrombin complex concentrates (PCCs) in cardiac surgery. The purpose of this review is to compare and contrast the use of FFP and PCC, review the components, limitations and risks of different types of PCCs, and discuss the latest evidence for the use of PCC versus FFP in cardiac surgery. ⋯ The current data supports the use of 4F-PCC instead of FFP as the primary hemostatic agent in cases of major bleeding in cardiac surgery. The use of PCCs is associated with reduced rates of RBC transfusions while maintaining a favorable safety profile. Clear advantages of PCC over FFP include its smaller volume, higher concentration of coagulation factors and shorter acquisition and administration times.
-
Curr Opin Anaesthesiol · Aug 2021
Review Meta AnalysisDrugs in anesthesia: preventing postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) continues to be a burden for patients, medical staff and healthcare facilities because of inadequate adherence to available recommendations. This review gives an overview on recent recommendations, new evidence and remaining issues in the field of PONV management. ⋯ Numerous drug (combinations) and strategies are available for PONV management. New and very effective (single) drugs could result in a simplification compared with a combination of several drugs, and thus lead to better implementation.
-
Curr Opin Anaesthesiol · Apr 2013
Meta AnalysisIntraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis.
It is uncertain whether patients undergoing short-lasting mechanical ventilation for surgery benefit from lung-protective intraoperative ventilatory settings including the use of lower tidal volumes, higher levels of positive end-expiratory pressure (PEEP) and/or recruitment maneuvers. We meta-analyzed trials testing the effect of lung-protective intraoperative ventilatory settings on the incidence of postoperative pulmonary complications. ⋯ Lung-protective intraoperative ventilatory settings have the potential to protect against postoperative pulmonary complications.