Current opinion in anaesthesiology
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Perioperative beta-blockade and statin therapy have been advocated to reduce cardiac risk of noncardiac surgery. This review evaluates recent articles published on the cardioprotective effects of perioperative therapy with these medications. ⋯ Based upon the available evidence and guidelines, patients currently taking beta-blockers should continue these agents. Patients undergoing vascular surgery who are at high cardiac risk should also take beta-blockers. The question remains regarding the best protocol to initiate perioperative beta-blockade. Statins should be continued in patients already taking these agents prior to surgery. The optimal duration and time of initiation of statin therapy remains unclear.
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Curr Opin Anaesthesiol · Feb 2008
ReviewAnesthetic management of patients undergoing extrapleural pneumonectomy for mesothelioma.
Extrapleural pneumonectomy is a radical and aggressive surgery that presents a great challenge to the thoracic anesthesiologist. This surgery is performed routinely by only a few centers in the world and this review represents our institution's experience in anesthetic care. ⋯ Anesthetic management importantly contributes to containment of the perioperative complications of extrapleural pneumonectomy. An appreciation of the technical aspects and physiologic disruptions associated with extrapleural pneumonectomy is critical to effective management. While data on this relatively uncommon surgical procedure are scarce, some referral centers have accumulated extensive experience. This review summarizes relevant surgical aspects and anesthetic insights from the Brigham and Women's Hospital experience. Included are the anesthetic implications of intraoperative intracavitary hyperthermic chemotherapy in combination with extrapleural pneumonectomy - an emerging therapeutic option in the treatment of malignant pleural mesothelioma.
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Curr Opin Anaesthesiol · Dec 2007
ReviewDuty hours restriction and their effect on resident education and academic departments: the American perspective.
Resident duty hour limits were implemented in 2003 by the Accreditation Council for Graduate Medical Education to improve resident wellness, increase patient safety and improve the educational environment of American residents. Now that academic anesthesiology departments and medical centers have had more than 3 years of experience under the duty hour rules, it is critical to review the available evidence on the effectiveness of these rules. ⋯ Accreditation Council for Graduate Medical Education duty hour rules are generally being followed by American anesthesiology residency programs. Residents perceive an improvement in their overall wellness, but it remains unclear if there has been an improvement in patient safety or quality of resident education.
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Curr Opin Anaesthesiol · Dec 2007
ReviewThe European Working Time Directive: effect on education and clinical care.
In 2009 the European Working Time Directive limits the weekly working hours to an average of 48 in all European Union member states. The recent published effects on education and patient care are discussed. ⋯ There are less measured clinical facts than political statements published. The actual working time directives in the European Union member states are inconsistent and further political development on this topic across the European Union remains unclear.
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Curr Opin Anaesthesiol · Dec 2007
ReviewBariatric procedures as day/short stay surgery: is it possible and reasonable?
There is an increasing tendency to extend the repertoire of procedures suitable for ambulatory care. The purpose of this review is to present recent information on progress in bariatric surgery and anaesthesia for morbidly obese patients, specifically looking for clinical reports on the success and/or problems related to an ambulatory or short-stay setting. ⋯ Despite proper safety and feasibility, it may still be a question of patient quality and acceptance for increasing the number of bariatric procedures performed as true ambulatory care. There is definitely potential for doing most of these procedures on a short-stay basis, however, allowing for a low threshold for individual management of those patients who require more extensive care.