Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2009
ReviewManagement of mini-cardiopulmonary bypass devices: is it worth the energy?
To address the role of mini-cardiopulmonary bypass systems in cardiac operations, with specific respect to clinical outcome. ⋯ Mini-cardiopulmonary bypass systems reduce the need for allogeneic blood transfusions. Other improvements in postoperative outcome are more debated. They require a long learning curve and are more expensive. A cost analysis based on a large randomized controlled trial is still needed to clarify the potential future role of these systems in clinical practice.
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The present review evaluates the evidence available in the literature tracking perioperative mortality and morbidity as well as the pathogenesis and management of acute lung injury (ALI) in patients undergoing thoracotomy. ⋯ Knowledge of the perioperative risk factors of major complications and understanding of the mechanisms of postthoracotomy ALI enable anesthesiologists to implement 'protective' lung strategies including the use of low tidal volume (VT) with recruitment maneuvers, a goal-directed fluid approach and prophylactic treatment with inhaled beta2-adrenergic agonists.
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Curr Opin Anaesthesiol · Feb 2009
ReviewCurrent aspects of perioperative fluid handling in vascular surgery.
Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate existing data when planning perioperative fluid management. This review aims to summarize the underlying facts. ⋯ The basis of fluid therapy in vascular surgery is a careful differential indication of the respective classes of preparations. A goal-directed approach might help to avoid hypovolaemia.
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Curr Opin Anaesthesiol · Feb 2009
ReviewAnesthesia in adult patients with congenital heart disease.
Recent advances in prenatal diagnosis, interventional cardiology, pediatric cardiac surgery, anesthesia, and critical care have resulted in an increasing number of adult patients with congenital heart disease (CHD). Most of these patients will require noncardiac surgery thus presenting a new challenge for anesthesiologists. The purpose of this article is to summarize preoperative and intraoperative implications for the anesthesiologist in the noncardiac surgery setting. ⋯ The number of adult patients with CHD is now superior to the number of children. This is a new challenge for anesthesiologist in the noncardiac surgery settings.
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Curr Opin Anaesthesiol · Feb 2009
ReviewUpdate on one-lung ventilation: the use of continuous positive airway pressure ventilation and positive end-expiratory pressure ventilation--clinical application.
The purpose of this review is to examine the evidence for and the clinical use of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) for the management of one-lung ventilation during thoracic surgery. CPAP and PEEP use are important as we are increasingly challenged with patients with less respiratory reserve and greater comorbidity leading to the need for greater clinical management and more interventions during one-lung ventilation for thoracic surgery to prevent perioperative complications. ⋯ CPAP and PEEP are useful not only to treat hypoxia and atelectasis as the consequence of one-lung ventilation, perhaps more importantly, also as part of a protective lung-ventilation strategy to ameliorate mechanical stress and prevent acute lung injury.