Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2016
ReviewFast track in thoracic surgery and anaesthesia: update of concepts.
Update of key elements on enhanced recovery after thoracic anaesthesia and surgery. ⋯ The concept of enhanced recovery ('fast-track') after thoracic surgery and anaesthesia was developed in recent years making allowance to the increased number of video-assisted parenchymal lung resections in managing primary lung cancer. Current studies promote the benefit in thoracic surgical patients, if an established departmental protocol-based algorithm is implemented.
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Cardiac surgery is associated with a wide range of microvascular derangements and with reduced tissue oxygenation. Although the macrohemodynamical targets during surgery may be achieved, the microcirculation may be damaged and remain dysfunctional. Direct observations of the microcirculation may enable more physiologically based approaches for diagnosis and treatment during cardiac surgery. ⋯ Direct visualization of the microcirculation using hand-held microscopy may provide the clinician the physiological feedback that is required for the early diagnosis and treatment of microcirculatory alterations during cardiac surgery. The coherence between the hemodynamic response of the macrocirculation and microcirculation during surgery seems to be essential.
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Curr Opin Anaesthesiol · Feb 2016
ReviewTransthoracic echocardiography in the perioperative setting.
A need for further assessment of patients in the perioperative setting and an increasing availability of ultrasonography equipment have facilitated the diffusion of ultrasonography and lately focused transthoracic echocardiography (TTE) in anesthesiology practice. This review will discuss the possible use of focused TTE in the perioperative setting and provides an update on present and future perspectives. ⋯ Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.
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Curr Opin Anaesthesiol · Feb 2016
ReviewAnaesthesia for thymectomy in adult and juvenile myasthenic patients.
Myasthenia gravis, a chronic disease of the neuromuscular junction, is associated with an interaction with neuromuscular blocking agents (NMBAs). As thymectomy is often the method of choice for its treatment, anaesthetic management requires meticulous preoperative evaluation, careful monitoring, and adequate dose titration. The frequency of video-assisted thoracoscopic extended thymectomy (VATET) is also increasing, making the use of NMBA obligatory. The number of cases of the juvenile form has also increased over years; airway management in juvenile one-lung ventilation is another challenge. ⋯ Anaesthetic management of thymectomy in myasthenia gravis requires experience concerning different approaches. Sugammadex should be considered as a possible further step toward postoperative safety.
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This article focuses on the recent findings in the diagnosis and treatment of diastolic heart failure (DHF) or heart failure with preserved ejection fraction. ⋯ The understanding of the phenotypic heterogeneity and multifactorial pathophysiology of DHF may lead to novel therapeutic targets in the future. Currently, the key to the treatment of DHF is aggressive management of contributing factors.