Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2013
ReviewAnesthesia for tracheal reconstruction and transplantation.
Tracheobronchial lesions requiring significant resection of the airway have limited surgical options and present significant obstacles to the anesthesiologist and surgeon. This article will review recent advancements in anesthetic and surgical management. ⋯ Significant leaps in tissue engineered airway transplantation have created curative options for patients previously considered inoperable. These patients pose significant challenges to the anesthesiologist during the entire perioperative period. Close collaboration with surgeons and intensivists and the use of recently developed systems for extracorporeal life support are required.
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Curr Opin Anaesthesiol · Feb 2013
ReviewAnesthetic considerations for interventional pulmonary procedures.
To discuss the anesthetic considerations of various procedures now performed by the interventional pulmonologist. With recent technological advances, many of these procedures represent acceptable alternatives to the invasive surgical procedures. For example, the placement of endobronchial valves can substitute for lung reduction surgery and can greatly reduce the postoperative recovery period. However, many of these complex procedures require anesthesia services. The nature and indication for the procedure as well as the patient's overall health will have an impact on the anesthetic choice. ⋯ As the array of diagnostic and therapeutic pulmonary interventions is expanding, the types of anesthetic techniques and ventilatory modes are varying to fit the procedural requirements. Some pulmonary procedures are best accomplished in the lightly sedated patient, who is breathing spontaneously, whereas procedures that use the working channel of a rigid bronchoscope are better performed in the patient under general anesthesia and mechanical ventilation that often use jet ventilation to minimize respiratory movements.
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This review presents the current available data to date regarding the perioperative risks associated with fluid management in thoracic surgery and its implications on the development of acute lung injury (ALI) as well as acute kidney injury (AKI). ⋯ Alternative fluid regimens to the traditional restrictive protocols used during thoracic surgery are being explored. These include normovolemic and goal-directed therapy protocols and the use of newer colloid solutions.
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Curr Opin Anaesthesiol · Feb 2013
ReviewExtracorporeal membrane oxygenation as an alternative to ventilation.
Following the recent H1N1 epidemic, there has been renewed interest in using extracorporeal membrane oxygenation (ECMO) as a treatment for acute respiratory failure. Currently, following the advances in technology, ECMO is now recommended as a definitive treatment for acute respiratory failure. However, there have been limited randomized trials and cohort studies evaluating this therapy. ⋯ Further studies are warranted to define and validate the role of ECMO, including studying the pharmacodynamics and pharmacokinetics of patients receiving support. The use of sedatives and antibiotics may be required to be changed significantly. If the incidence of intracerebral haemorrhage can be decreased, then in the author's opinion it may become the first-line treatment for acute respiratory failure.
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Curr Opin Anaesthesiol · Feb 2013
ReviewPreoperative identification of patients with increased risk for perioperative bleeding.
Although the overall complication rate in cardiac surgery has been decreased, perioperative bleeding increasing morbidity and mortality is still frequent. Furthermore, the widespread use of new antithrombotic and antiplatelet agents presents an additional challenge in daily practice. Therefore, identifying patients with increased bleeding risk would be advantageous to optimize perioperative management. ⋯ Apart from precise bleeding history only insufficient data exist in cardiac surgery to exactly predict bleeding complications. Therefore, there is urgent need for further studies to improve perioperative bleeding management.