Current opinion in anaesthesiology
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This article provides the reader with recent findings on the pathophysiology of comorbidities in the obese, as well as evidence-based treatment options to deal with perioperative respiratory challenges. ⋯ Anesthesia of obese patients for nonbariatric surgical procedures requires knowledge of typical comorbidities and their respective treatment options. Apart from cardiovascular diseases associated with the metabolic syndrome, awareness of any pulmonary dysfunction is of paramount. A multimodal analgesia approach may be useful to reduce postoperative pulmonary complications.
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Curr Opin Anaesthesiol · Jun 2016
ReviewMyocardial injury after noncardiac surgery: an underappreciated problem and current challenges.
To review myocardial injury after noncardiac surgery (MINS), focusing on recent studies, including data on high-sensitivity troponin, which is likely to alter our understanding of MINS. ⋯ Currently, we are limited to appreciating the vast extent of the MINS problem and applying recommendations based on observational data or derived from the nonoperative setting. Routine troponin measurements after noncardiac surgery and the increasing use of high-sensitivity troponins have revealed the larger underwater iceberg of perioperative myocardial injury and ischemia. Clinicians should be sensitized for this important complication and search for it using a perioperative troponin screening.
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Congestive heart failure (CHF) is one of the most common diseases of the elderly patient. The underlying pathophysiology varies considerably and approximately 50% of the patients suffer from CHF with reduced left ventricular ejection fraction. Mortality in the perioperative period is increased in patients with CHF and this holds true for both minor and major surgeries. This review will summarize recent literature in the field of CHF and perioperative outcome in patients undergoing surgery with a special emphasis on actual guidelines, preoperative assessment and appropriate perioperative therapy. ⋯ CHF is a source of considerable perioperative morbidity and mortality and in contrast to coronary artery disease, knowledge is very limited and additional research urgently needed.
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Managing the bleeding pediatric patient perioperatively can be extremely challenging. The primary goals include avoiding hypotension, maintaining adequate tissue perfusion and oxygenation, and maintaining hemostasis. Traditional bleeding management has consisted of transfusion of autologous blood products, however, there is strong evidence that transfusion-related side-effects are associated with increased morbidity and mortality in children. Especially concerning is the increased reported incidence of noninfectious adverse events such as transfusion-related acute lung injury, transfusion-related circulatory overload and transfusion-related immunomodulation. The current approach in perioperative bleeding management of the pediatric patient should focus on the diagnosis and treatment of anemia and coagulopathy with the transfusion of blood products only when clinically indicated and guided by goal-directed strategies. ⋯ This article will highlight current guidelines in perioperative bleeding management for our most vulnerable pediatric patients with emphasis on individualized targeted intervention using point-of-care testing and specific coagulation products.
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Curr Opin Anaesthesiol · Jun 2016
ReviewPatients prone for postoperative delirium: preoperative assessment, perioperative prophylaxis, postoperative treatment.
The aim of this study was to review current literature on identification of patients at risk for postoperative delirium (POD) and to summarize recent findings on prophylaxis and treatment. ⋯ An increase of the proportion of elderly patients undergoing surgery will lead to a higher incidence of POD. Preoperative assessment should facilitate identification of patients at high risk. Perioperative management should include monitoring depth of anesthesia, preference for nonopioid pain therapy, early regular delirium monitoring starting in the recovery room, avoiding ICU-sedation, early mobilization and exercise, and cognitive training.