Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2023
Review Meta AnalysisIs venoarterial extracorporeal membrane oxygenation an option for managing septic shock.
To describe sepsis-induced cardiomyopathy. Discuss indications and current evidence of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) in setting of sepsis-induced cardiomyopathy. ⋯ Sepsis-induced cardiomyopathy is an increasingly recognized entity characterized by reversible ventricular dysfunction in the setting of sepsis. When hypotension persists despite standard management of septic shock (e.g. adequate fluid resuscitation, vasopressors, inotropes) and there is evidence of severe cardiac systolic dysfunction and end-organ hypoperfusion, VA-ECMO should be considered as a bridge therapy to recovery. VA-ECMO should not be used for isolated vasodilatory septic shock without significant myocardial dysfunction.
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Curr Opin Anaesthesiol · Feb 2023
ReviewPostoperative/postdischarge nausea and vomiting: evidence-based prevention and treatment.
Postoperative/postdischarge nausea and vomiting (PONV/PDNV) remains a relevant issue in perioperative care. Especially in outpatient surgery, PONV can prevent discharge or lead to unplanned readmission. ⋯ A liberal, universal PONV management is now endorsed by the guidelines. Specific evidence concerning prevention and (at-home) treatment of PDNV is still scarce.
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Curr Opin Anaesthesiol · Feb 2023
ReviewLung transplantation for coronavirus disease 2019 associated severe acute respiratory distress syndrome.
The purpose of this review is to analyze the most recent and relevant literature involving lung transplantation for coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS), the pathological mechanisms of lung injury, selection criteria and outcomes. ⋯ Lung transplantation after COVID-19 ARDS is a potentially life-saving procedure for appropriately selected patients with no evidence of lung function recovery despite maximal treatment. Lung transplantation should be ideally performed in high-volume centers with expertise.
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Spinal cord injury (SCI) is one of the biggest complications in open and endovascular aortic repairs. Historically, cerebrospinal fluid drains (CSFD) have been one of the most effective modalities in reducing SCI and one of the most studied. CSFD placement also carries its' own set of procedural risks. This editorial intends to evaluate recent literature to determine whether CSFDs remain a valuable tool in aortic repair. ⋯ There has been conflicting data on whether CSFDs have a role in reducing the risk of SCI in endovascular aortic repair. Some studies suggest that there is no benefit to placement while others suggest that routine prophylactic drains should be placed for all endovascular cases. Despite this, efforts have been made to selectively place CSFDs in those patients deemed at 'high risk' for SCI. CSFDs also remain a part of rescue treatment for postoperative SCI. This suggests that CSFDs continue to be a valuable tool that we need to better comprehend. Future research is necessary to better understand how patient risk factors can be balanced with perioperative management to help identify patients who may benefit from CSFD placement.
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Curr Opin Anaesthesiol · Feb 2023
ReviewLateral thoracotomy versus sternotomy for left ventricular assist device implantation.
Traditionally, left ventricular assist devices (LVADs) are implanted via the standard median sternotomy approach. However, a left thoracotomy approach has been purported to offer physiologic benefits. As a result, utilization of the left thoracotomy for LVAD placement is increasing globally, but the benefits of this approach versus sternotomy are still evolving and debatable. This review compares the median sternotomy and thoracotomy approaches for LVAD placement. ⋯ The most recent literature supports the use of lateral thoracotomy for placement of left ventricle assist devices compared to median sternotomy. Long-term outcomes from lateral thoracotomy are still unknown, however, short-term results favor lateral thoracotomy approaches for LVAD implantation. While the conventional median sternotomy approach was the original operative technique of choice for LVAD implantation, lateral thoracotomy is quickly emerging as a potentially superior technique.