Current opinion in anaesthesiology
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To discuss the innovations in general thoracic surgery and how they affect anesthetic management perioperatively. However, rather than listing various thoracic procedures and their inherent issues that complicate providing anesthesia, the approach of this article is to raise the anesthetic issues associated with innovations in thoracic surgery perceived to be important by the thoracic surgeon. ⋯ Innovations in thoracic surgery continually emerge and challenge thoracic surgeons and anesthesiologists to evaluate their utility and benefits. The increased adoption of minimally invasive operations is a testament to this collaboration. This process requires an ongoing dialog between the clinicians within these two disciplines to advance the science of surgery.
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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.
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Anesthesiologists work in a complex environment that is intolerant of errors. Cognitive errors, or errors in thought processes, are mistakes that a clinician makes despite 'knowing better'. Several new studies provide a better understanding of how to manage risk while making better decisions. ⋯ Effective decision-making and risk management reduce the risk of adverse events in the operating room. This article proposes several new decision-making and risk assessment tools for use in the operating room.