Current opinion in anaesthesiology
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To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international guidelines on enhanced recovery after surgery (ERAS). ⋯ The goal of perioperative euvolemia can be achieved with the ongoing evolution and application of ERAS principles. A focus on the pre and postoperative phases of fluid management and a pragmatic approach to intraoperative fluid management negates the need for goal-directed fluid therapy in most cases.
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Curr Opin Anaesthesiol · Feb 2024
ReviewGet your 7-point golden medal for pain management in video-assisted thoracoscopic surgery.
Thoracic surgery is evolving, necessitating an adaptation for perioperative anesthesia and analgesia. This review highlights the recent advancements in perioperative (multimodal) analgesia for minimally invasive thoracic surgery. ⋯ In the realm of minimally invasive thoracic surgery, perioperative analgesia is typically administered through systemic and regional techniques. Nevertheless, collaboration between anesthesiologists and surgeons, utilizing surgically placed nerve blocks and an active chest drain management, has the potential to significantly improve overall patient care.
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Although team-based care has been shown in many sectors to improve outcomes, very little work has been done with the thoracic surgical patient. This review article focuses on this and, extrapolating from other closely related surgical fields, teamwork in thoracic surgery will be reviewed for outcome efficacy and substance. ⋯ To improve outcome, the thoracic surgical team, centered on the anesthesiologist and surgeon, will display the 'Big 5' attributes of highly effective teams. There are attributes of poor teams, which the dyad should avoid in order to increase the team's function and thus outcome.
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Curr Opin Anaesthesiol · Feb 2024
ReviewUpdate on minimally invasive cardiac surgery and enhanced recovery after surgery.
Numerous recent trials have examined the potential benefits of treating cardiac surgery patients with a minimally invasive approach. Recently, Enhanced Recovery After Surgery (ERAS) has also been applied to cardiac surgery, and specifically to minimally invasive cardiac surgery (MICS) patients. This review will explore current evidence regarding MICS, as well as the combination of MICS plus ERAS. ⋯ Minimally invasive cardiac surgery appears to provide patients with equivalent or better outcomes, faster recovery, and less surgical trauma compared to full sternotomy. The addition of ERAS phase specific perioperative protocols can help maximize the benefits of MICS.
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Patients undergoing cardiac surgery are at high risk to develop cardiac surgery-associated acute kidney injury (CS-AKI) postoperatively. CS-AKI is associated with an increased risk for persistent renal dysfunction, morbidity and mortality. This review summarizes the epidemiology and pathophysiology of CS-AKI, as well as current treatment and prevention strategies. ⋯ Based on the described novel approaches for early detection, prevention and management of CS-AKI, a precision-medicine approach should be implemented in order to prevent the development of AKI in patients undergoing cardiac surgery.