Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2010
ReviewUse of echocardiography and modalities of patient monitoring of trauma patients.
Trauma patients require evaluation of the anatomic structure as well as the hemodynamic profile of the heart to improve effectiveness of resuscitation. They are prone to hemodynamic instability and must be monitored with various modalities to detect deterioration early. Newer, less invasive ultrasound technologies are replacing familiar 'gold standard' modalities of the past. This article reviews the indications, roles, imaging approaches, and limitations of modern echocardiography. A brief review of other ICU monitoring modalities is also presented. ⋯ Echocardiography plays an important role in the trauma bay for diagnosis of thoracic injury and at the bedside in the ICU for evaluation of the hemodynamic profile.
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Curr Opin Anaesthesiol · Feb 2010
ReviewAnesthesia for patients with severe chronic obstructive pulmonary disease.
Patients with chronic obstructive lung disease experience an increased risk of perioperative pulmonary complications. This review presents an evidence-based approach to perioperative care designed to optimize management. ⋯ Optimization for surgery includes preoperative treatment of reversible airway obstruction and respiratory infections, smoking cessation, and possibly nutritional interventions. Meticulous intraoperative monitoring combined with a sound understanding of pathophysiological mechanisms underlying air trapping will help clinicians strike a balance between permissive hypercapnia and adequate ventilation.
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Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it. ⋯ Identification of high-risk patients, the use of balanced anesthesia techniques and increased vigilance on the part of the anesthetist will go a long way in preventing intraoperative awareness. There is evidence that using processed EEG monitors reduces the incidence of awareness. However, understanding their limitations and interpatient variability in dose-response curves, and interpreting the data in relation to the specific drugs and techniques used is paramount.
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Curr Opin Anaesthesiol · Feb 2010
ReviewLung isolation techniques for patients with difficult airway.
One-lung ventilation in the thoracic surgical patient can be achieved with the use of a double-lumen endotracheal tube or an independent bronchial blocker. A number of patients requiring lung isolation have a potentially difficult airway because of previous radiation to the neck or previous surgery to the tongue and larynx. This review will focus on the management of patients who have a difficult airway and require lung isolation. ⋯ In patients who require one-lung ventilation and who present with a difficult airway, the safest way to establish an airway is by placing a single-lumen endotracheal tube orally or nasotracheally while the patient is awake with the aid of a flexible fiberoptic bronchoscope. Lung isolation in these patients then is achieved by using an independent bronchial blocker; an alternative technique is to use a double-lumen endotracheal tube while using an airway catheter exchange technique. For the patient with a tracheostomy in place, an independent bronchial blocker is recommended.