Current opinion in anaesthesiology
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The management of patients with recent coronary artery stents presenting for noncardiac surgery has become a major topic of interest and concern for all perioperative caregivers. This review will update recent reports and particularly new guidelines as well as recommendations. ⋯ Anaesthesiologists may understand the specific problem of drug-eluting stents, the recent debate among cardiologists and the implications for the perioperative scenario.
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Curr Opin Anaesthesiol · Feb 2008
ReviewGenetic and environmental determinants of postthoracotomy pain syndrome.
Pain after thoracic surgery may persist for up to a year or longer in as many as 50% of patients undergoing lung resection. There is currently no specific therapy, and our ability to predict who will develop a persistent pain syndrome is poor at best. Persistent pain after thoracotomy is not an acute somatic pain, rather it is a complex syndrome with many of the characteristics of neuropathic, dysesthetic pain. ⋯ Postthoracotomy pain syndrome likely arises as a direct result of an environmental stress (surgery) occurring on a landscape of susceptibility that is determined by an individual's behavioral, clinical and genetic characteristics.
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Curr Opin Anaesthesiol · Feb 2008
ReviewA logical approach to the selection and insertion of double-lumen tubes.
There has been a progressive evolution in double-lumen tubes to separate the right and left lungs. The appreciation of the anatomical advantage of the longer left main bronchus has directed anesthetists to prefer a left tube if possible for lung separation. Understanding the dimensions of the tube as well as the variations in the left main bronchus has improved the process of selection and insertion of the double-lumen tubes for lung isolation. ⋯ Measurement of patient's airway dimensions combined with knowledge of the dimensions of the double-lumen (tracheobronchial) tube plays an important role in lung separation.
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Pulmonary endarterectomy is the treatment of choice for many patients with chronic thromboembolic pulmonary hypertension. Although potentially curative, some patients receive no benefit and have poor outcomes. This review will look at the new research in the pathophysiology of the disease and developments in perioperative care, which may help to understand the difference in outcomes. ⋯ Pulmonary endarterectomy is a successful treatment of chronic thromboembolic pulmonary hypertension. Better understanding of the underlying pathophysiology will help in patient selection for surgical intervention.
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Recent publications have reported on the neurologic complications in cardiovascular surgery. They are frequent, and have surpassed the mortality rate in cardiac surgery. Brain injury compromises surgical results and the patient's outcome. This review reports on the recent literature on neuromonitoring tools used to prevent and reduce brain injury in cardiovascular surgery. ⋯ Neuromonitoring tools may guide both intervention and treatment, and are aimed at reducing brain damage during cardiovascular surgery, especially when combined in multimodality monitoring. Further prospective, double-blind, randomized outcome studies are needed to determine the optimal neurologic monitoring modality (or modalities) in specific surgical settings.