Journal of anesthesia
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Journal of anesthesia · Feb 2021
ReviewPredicting cardiac risk in noncardiac surgery: a narrative review.
Risk stratification endeavors to categorize patients into groups based on the level of risk for each group. Improved perioperative screening tests using more sensitive cardiac biomarkers have revealed that about 68% of perioperative myocardial infarctions (MI) are asymptomatic and may only be detected by routine postoperative screening with troponin measurements. This is important since myocardial injury not meeting criteria for myocardial infarction is associated with increased risk of 30-day mortality (Botto et al. in Anesthesiology 120:564-578, 2014). ⋯ Incorporating serum biomarkers into updated clinical risk indices is likely to improve their performance. Further studies are needed to determine appropriate clinical interventions to treat isolated elevations in cardiac troponin levels and further mitigate the increased risk of morbidity and mortality. The objective of this review is to summarize the current literature on the clinical diagnoses of perioperative myocardial injury in the setting of noncardiac surgery.
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Journal of anesthesia · Dec 2020
ReviewAligning difficult airway guidelines with the anesthetic COVID-19 guidelines to develop a COVID-19 difficult airway strategy: a narrative review.
The coronavirus disease 2019 (COVID-19) pandemic is caused by a coronavirus that is transmitted primarily via aerosol, droplets or direct contact. This may place anesthetists at higher risk of infection due to their frequent involvement in aerosol-generating airway interventions. Many anesthethetic COVID-19 guidelines have emerged, whose underlying management principles include minimizing aerosol contamination and protecting healthcare workers. ⋯ Our article identifies and compares pre-pandemic difficult airway guidelines with the recent anesthetic COVID-19 guidelines. We combine the principles from both sets of guidelines and explain the necessary modifications to the airway guidelines, to form a failed tracheal intubation airway strategy in the COVID-19 patient. Valuing, and a greater understanding of, these differences and modifications may lead to greater adherence to the new COVID-19 guidelines.
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Journal of anesthesia · Dec 2020
ReviewAnalogy between classical Yoga/Zen breathing and modern clinical respiratory therapy.
Anesthesiologists and intensivists are modern-day professionals who provide appropriate respiratory care, vital for patient survival. Recently, anesthesiologists have increasingly focused their attention on the type of spontaneous breathing made by non-intubated patients with pulmonary disease cared for in an intensive care unit, and also patients with chronic pain receiving cognitive behavioral therapy. Prior to our modern understanding of respiratory physiology, Zen meditators recognized that breathing has a significant impact on a person's mental state and general physical well-being. ⋯ In the present review, we examine the effect of classical breathing methods and find an analogy between typical Yoga/Zen breathing and modern clinical respiratory therapy. Evidence is increasing about historical breathing and related meditation techniques that may be effective in modern clinical practice, especially in the field of anesthesiology, such as in improving respiratory function and reducing chronic pain. Clarification of the detailed mechanisms involved is anticipated.
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Journal of anesthesia · Oct 2020
ReviewAn overview of management of intracranial hypertension in the intensive care unit.
Intracranial hypertension (IH) is a clinical condition commonly encountered in the intensive care unit, which requires immediate treatment. The maintenance of normal intracranial pressure (ICP) and cerebral perfusion pressure in order to prevent secondary brain injury (SBI) is the central focus of management. SBI can be detected through clinical examination and invasive and non-invasive ICP monitoring. ⋯ To control elevated ICP refractory to maximum standard medical and surgical treatment, at first, high-dose barbiturate administration and then decompressive craniectomy as a last step are recommended with unclear and probable benefit on outcomes, respectively. The therapeutic strategy should be based on a staircase approach and be individualized for each patient. Since most therapeutic interventions have an uncertain effect on neurological outcome and mortality, future research should focus on both studying the long-term benefits of current strategies and developing new ones.
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Journal of anesthesia · Oct 2020
ReviewEvaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?
Non-protocolized fluid administration in critically ill patients, especially those with acute respiratory distress syndrome (ARDS), is associated with poor outcomes. Therefore, fluid administration in patients with Coronavirus disease (COVID-19) should be properly guided. Choice of an index to guide fluid management during a pandemic with mass patient admissions carries an additional challenge due to the relatively limited resources. ⋯ However, the preload modifying maneuvers were not extensively evaluated outside the operating room. Selection of the proper test would vary according to the level of healthcare in the country and the load of admissions which might be overwhelming. Evaluation of the volume status should be comprehensive; therefore, the presence of signs of volume overload such as lower limb edema, lung edema, and severe hypoxemia should be considered beside the usual indices for fluid responsiveness.