Current opinion in anaesthesiology
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Describe the importance of monitoring dead space during thoracic surgery, specifically during one-lung ventilation. ⋯ Monitoring dead space helps anesthesiologists monitor the status of the lung and find appropriate ventilatory settings during thoracic surgeries.
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Curr Opin Anaesthesiol · Feb 2015
ReviewTransesophageal echocardiography in thoracic anesthesia: pulmonary hypertension and right ventricular function.
Pulmonary hypertension is associated with increased postoperative morbidity and mortality. Early diagnosis and echocardiographic detection of right ventricular (RV) dysfunction are paramount in perioperative management. The goal of this review is to provide an overview of the recent literature on this topic. ⋯ More pulmonary hypertension patients are presenting for noncardiac surgery, creating a challenge for the anesthesiologist. Echocardiographic detection of RV dysfunction can be difficult. Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not advocated yet, but the development of automated techniques may provide an objective assessment of RV function.
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Curr Opin Anaesthesiol · Feb 2015
ReviewDiastolic dysfunction, diagnostic and perioperative management in cardiac surgery.
The review focuses on recent findings on the role of diastolic dysfunction in the perioperative period and on recent advances in the diagnosis and perioperative management of diastolic function. ⋯ Appropriate perioperative patient care requires that the perioperative physician be alerted to the presence of diastolic dysfunction, be knowledgeable of the diastolic dysfunction grading system and understand the pathophysiologic changes associated with various grades of diastolic function.
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The mean age of patients presenting for thoracic surgery is rising steadily, associated with an increased demand for thoracic surgical treatments by geriatric patients. With increasing age, physiologic changes and comorbidities have to be considered. Thoracic anesthesia for elderly patients requires greater specific knowledge. ⋯ Considering key points of physiology and pharmacology can help to provide best possible care for the increasing number of elderly patients in thoracic surgery. Management of geriatric patients in thoracic surgery offer opportunities for anaesthetic interventions including protective ventilation, use of different anesthetics, anaesthesia monitoring, fluid management and pain therapy.
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Curr Opin Anaesthesiol · Feb 2015
ReviewExpanding role of perioperative transesophageal echocardiography in the general anesthesia practice and residency training in the USA.
To review the perioperative use of noncardiac transesophageal echocardiography in anesthesiology and to explore the current mechanisms of teaching and certification. ⋯ Transesophageal echocardiography can have many helpful uses in perioperative patient care. This study summarizes many noncardiac uses, certification, and echocardiography education for anesthesiologists.