Current opinion in anaesthesiology
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The current economic climate has put pressure on healthcare systems and providers, including anesthesiologists, to minimize costs without sacrificing patient safety. In this review, we discuss costs associated with anesthesia care, including medications and intraoperative monitoring, and suggest ways to reduce wastes and overall expenditure. ⋯ Anesthesia medications comprise a significant proportion of hospital pharmacy budgets. Average anesthesia-related cost reductions of US$ 13-30 per cases multiplied by 25 million anesthetics administered annually in the USA has the potential to yield savings of US$ 350-750 million. Bispectral index monitoring during inhalational anesthesia adds to the cost without providing any benefit.
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Lung transplantation has been one of the great medical advances as the last option for the treatment of end-stage pulmonary disease. Optimal pulmonary care of potential donors and recipients can definitely increase the number of successful lung retrievals and reduce the incidence of complications. ⋯ Perioperative ventilatory care of the transplanted patient still represents a challenge for the ICU clinician. The lung-protective strategy and the early application of carbon dioxide removal systems can increase the number of lung donor eligibility. Further studies are needed to increase the viability of other organs and to develop new strategies that reduce the risk of ischemia-reperfusion injury, which still represents the most common complication in the postoperative period.
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Curr Opin Anaesthesiol · Apr 2012
ReviewSpontaneous breathing activity in acute lung injury and acute respiratory distress syndrome.
We aimed at providing the most recent and relevant evidence regarding spontaneous breathing activity during mechanical ventilation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Both clinical and experimental data are depicted. ⋯ In our opinion, spontaneous breathing activity should be avoided in the first 48 h of mechanical ventilation in patients with severe ARDS (PaO2/FIO2 <120 mmHg), but it may be useful in less severe ARDS and ALI. Clearly, further clinical and experimental investigations on the use of different ventilation modes of supported/unsupported spontaneous breathing in ALI/ARDS are needed.
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Conventional wisdom maintains that multiple aspects of surgical technique and management may affect postoperative outcome, while anaesthetic technique has little long-term effect on patient outcomes. There is accumulating evidence that, on the contrary, anaesthetic management may in fact exert a number of longer-term effects in postoperative outcome. Here, we review the most topical aspects of anaesthetic management which may potentially influence later postoperative outcomes. ⋯ Further prospective, large-scale human trials with long-term follow-up are required to clarify the association between anaesthesia and cancer recurrence, neurotoxicity and the developing brain and long-term postoperative cognitive dysfunction in the elderly.
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Computed tomography (CT) has fostered pivotal advancements in the understanding of acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury. Apart from CT-based studies, the past years have seen fascinating work using positron emission tomography, electrical impedance tomography and lung ultrasound as diagnostic tools to optimize mechanical ventilation. This review aims to present the major findings of recent studies on lung imaging. ⋯ Whereas quantitative CT remains the gold standard to assess lung morphology, recruitment and hyperinflation of lung tissue at different inflation pressures, EIT and LUS have emerged as valuable, radiation-free, noninvasive bedside lung imaging tools that should be used together with global parameters like lung mechanics and gas exchange to acquire additional information on recruitability and ventilation distribution.