Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2015
ReviewStrategies to reduce blood transfusion: a Latin-American perspective.
Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion. ⋯ An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
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Hypercapnia is a central component of diverse respiratory disorders, while 'permissive hypercapnia' is frequently used in ventilatory strategies for patients with severe respiratory failure. This review will present data from recent studies relating to hypercapnia, focusing on issues that are of importance to anesthesiologists caring for the surgical and/or critically ill patient. ⋯ The mechanisms of action of hypercapnia and acidosis continue to be elucidated, and this knowledge is central to determining the safety and therapeutic utility of hypercapnia in protective lung ventilatory strategies.
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Aortic stenosis is the most frequent valvular heart disease in the USA, and aortic valve replacement remains the only definitive treatment. For patients who cannot have surgery or who are at an increased risk for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) has become an established treatment option. New technological developments in valve design will make TAVR available to an even wider group of patients. This review describes the TAVR procedure and its critical stages. ⋯ TAVR is a treatment option for patients who are at an increased risk for SAVR. Evolving technology will likely expand the patient population eligible for this type of treatment in the very near future. Multidisciplinary heart team is essential in improving current techniques and patient selection, as well as evaluating new technologies.
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Curr Opin Anaesthesiol · Feb 2015
Review Case ReportsPreoperative evaluation of the patient with lung cancer being considered for lung resection.
This review summarizes the general approach to evaluating the cardiopulmonary fitness of a patient with lung cancer being considered for lung resection. Many patients have a high risk for morbidity and mortality from lung resection owing to severe comorbidities or low cardiopulmonary reserve. A comprehensive and individualized assessment is essential to identify the factors that may impact operative outcome. ⋯ Preoperative assessment requires an understanding of the relative benefits and harms of available treatment options and consideration of patients' values. A balance between the potential to cure one's cancer and the short-term and long-term risks of the selected treatment needs to be reached. All patients should have a baseline FEV(1) and DL(CO) measured, and predicted postoperative FEV(1) and DL(CO) calculated to assist with risk prediction. Measures of exercise performance can help to further risk stratify patients. Means of modifying the risks should be considered for all patients.
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Acute kidney injury (AKI) is a long-recognized complication of cardiac surgery. It is a commonly encountered clinical syndrome that, in its most severe form, increases the odds of operative mortality three to eight-fold. The pathogenesis of cardiac surgery-associated acute kidney injury (CSA-AKI) is complex. No single intervention is likely to provide a panacea, and thus, the purpose of this review is to assess the wide breadth of emerging research into potential strategies to prevent, diagnose, and treat CSA-AKI. ⋯ Although there has been much high-quality research conducted in this field in recent years, preventing CSA-AKI by avoiding renal insults remains the mainstay of management. Although biomarkers have the potential to diagnose CSA-AKI at an earlier stage, efficacious interventions to treat established CSA-AKI remain elusive.