Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2015
ReviewAcute trauma and multiple injuries in the elderly population.
Traumatic injuries in the rapidly growing elderly population pose a significant challenge to the healthcare community. These injuries are associated with significant morbidity and mortality, and as a result cause a financial burden on the medical system. Although normal decline in physiologic reserve can provide some explanation for these poor outcomes, there is significant room for improvement. This review will summarize recent literature around the evaluation and management of elderly trauma patients with a particular focus on those with hip fractures. ⋯ Differentiated, geriatric-specific triaging, assessment and treatment pathways in the care of elderly trauma patients will ultimately lead to improvements in outcomes. These improvements have already started to be seen in the realm of orthogeriatrics.
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Positive inotropic agents are widely used in the management of the critical ill patient presenting with low cardiac output state. Different inotropic agents are available, and different effects on hemodynamic endpoints may be recognized, but data on relevant clinical endpoints are scarce. A growing body of literature suggests that overuse of inotropes may have detrimental effects on cardiomyocytes, resulting in an increased risk of morbidity and mortality. The present review will summarize recent literature, focusing on outcome studies among adult patients related to use of inotropes in different clinical settings. ⋯ A 'less is more' approach may show to be appropriate when relating to routine use of inotropes. Inotropic therapy should be restricted to patients with heart failure and clinical signs of end-organ hypoperfusion.
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Curr Opin Anaesthesiol · Feb 2015
ReviewPerioperative myocardial perfusion: an anesthesiologists' concern?
General anesthesia has only small effects on myocardial perfusion in healthy 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.
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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.