Current opinion in anaesthesiology
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Acute kidney injury (AKI) is a serious complication that significantly increases morbidity, mortality and cost of care after cardiac surgery. In this review we identify the current literature that addresses strategies for renal protection and the prevention of AKI after cardiac surgery. ⋯ Postoperative AKI is a serious complication after cardiac surgery. Therapeutic interventions and RRT have limited influence on the outcome of AKI, and a preventive strategy remains the mainstay to attenuate its impact.
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Perioperative acute pain and the development of persistent pain after thoracotomy are major problems severely affecting health-related quality of life. This review examines and highlights recent strategies and advances in perioperative pain management in this field. ⋯ Even though thoracotomy is associated with significant postoperative complications, a growing understanding of the underlying pathophysiology and advances in multimodal pain therapy concepts in this specific group of patients are promising improved postoperative outcomes and potential reduction of the incidence of persistent pain.
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Atrial fibrillation after cardiac surgery remains a very common and vexing clinical problem. This review summarizes recent clinical and laboratory investigations, the results of which may lead to a more effective strategy for the prevention of atrial fibrillation after cardiac surgery. ⋯ Atrial fibrillation after cardiac surgery remains a dysrhythmia with significant implications. A more comprehensive, multimodal preventive strategy, using preoperative beta-blockers and statins, perioperative magnesium and steroids, and preoperative amiodarone in high-risk patients should be rigorously evaluated.
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Curr Opin Anaesthesiol · Feb 2011
ReviewHypoxic pulmonary vasoconstriction: mechanisms of oxygen-sensing.
Hypoxic pulmonary vasoconstriction (HPV) is driven by the intrinsic response to hypoxia of pulmonary arterial smooth muscle and endothelial cells. These are representatives of a group of specialized O2-sensing cells, defined by their acute sensitivity to relatively small changes in pO2, which have evolved to modulate respiratory and circulatory function in order to maintain O2 supply within physiological limits. The aim of this article is to discuss recent investigations into the mechanism(s) of hypoxia-response coupling and, in light of these, provide a critical assessment of current working hypotheses. ⋯ HPV supports ventilation-perfusion matching in the lung by diverting blood flow away from oxygen-deprived areas towards regions rich in O2. However, in diseases such as emphysema and cystic fibrosis, widespread HPV leads to hypoxic pulmonary hypertension and ultimately right heart failure. Determining the precise mechanism(s) that underpins hypoxia-response coupling will therefore advance understanding of the fundamental processes contributing to related pathophysiology and provide for improved therapeutics.