Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Apr 2003
Helicopter trauma transport: an overview of recent outcomes and triage literature.
The purpose of this review is to assess literature pertinent to outcomes benefits accrued by the use of helicopter emergency medical services for trauma transport. A previous annotated bibliography assessed literature published between 1980 and 2000. The goal of this paper is to address developments since fall 2001, and to cast recent studies in the light of earlier work in an attempt to provide a long-range overview of the relevant literature. ⋯ The preponderance of recent and previously extant evidence supports an argument that the helicopter emergency medical services transport is associated with significant benefit for some injured patients. The primary challenges at this time include the determination of which patients benefit and the elucidation of which aspects of the helicopter emergency medical services are responsible for any salutary effects of its utilization.
-
The past 35 years have provided a wealth of evidence that mechanical ventilation, although potentially life saving, can injure the lungs. Recent evidence suggests that limiting ventilating gas volumes can reduce patient mortality, but may result in progressive parenchymal derecruitment and alveolar hypoventilation, potentially aggravating systemic hypercarbia and hypoxemia. This review summarizes the current recommendations on a controversial, invasive technique termed 'extracorporeal life support' as a means to provide temporary pulmonary support during 'lung-protective' strategies. ⋯ Extracorporeal life support is an invasive technique that can provide support to the failing lung. Clinical trials have demonstrated its efficacy in neonatal and pediatric patients, but data in adults are less clear. An ongoing trial in the UK will soon address this important issue.
-
There is growing evidence that in end-stage shock or during cardiac arrest, inappropriately low endogenous vasopressin plasma levels may be responsible for pathologic vasodilatation, inadequate organ perfusion, and poor outcome. The purpose of this article is to review recent publications featuring arginine vasopressin as a potent vasoconstrictor in various shock states such as systemic vasodilatation, severe hypovolemia, or cardiac arrest. ⋯ Vasopressin administration is emerging as a rational and promising therapy in the management of various shock states and cardiac arrest.
-
Discuss and summarize recent published literature related to the use of 'blood substitutes' in cardiac surgery patients. ⋯ One hemoglobin-based oxygen carrier (Hemopure) has been approved for use in humans in South Africa as well as another hemoglobin-based oxygen carrier (Gelenpol) and a perfluorocarbon (Perfluoron) in Russia. Phase III trials in Europe and North America will be concluded very soon. We anticipate seeing one or two products approved in North America and Europe by the year 2003/2004.
-
The present overview describes recent contributions to the literature with regard to choice of anesthetic techniques, approaches to anesthetic management of elderly outpatients undergoing arthroscopy and other procedures, reconsideration of the problem of postoperative delirium in the elderly patient, and a general summary of perioperative management and assessment of anesthetic risk in older adults. ⋯ The efficiency and speed with which outpatient surgery and anesthetic recovery can be conducted in older adults continue to improve. Monitors of depth of anesthesia, ultra-short-acting agents, and combined techniques have minimized minor complications such as nausea and vomiting, and have improved the speed with which these patients recover from anesthesia. A small proportion of elderly surgical outpatients remain at risk for residual postoperative cognitive dysfunction.