Current opinion in anaesthesiology
-
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.
-
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.
-
To survey the causes of ventilator-induced lung injury focusing on its mechanical determinants, lung stress and strain. ⋯ When lung protective strategy is considered unsafe, various techniques of extracorporeal respiratory support may be applied, which by decreasing the load of mechanical ventilation, allow partial to total lung rest.