Best practice & research. Clinical anaesthesiology
-
The ability to reduce brain injury before, during or after an ischaemic injury, irrespective of the cause, remains an exciting prospect. In this article, we will discuss some of the current research behind cerebral protection, which will include the use of anaesthetic agents, as well as therapies targeted specifically at the complex cascades following brain injury.
-
Best Pract Res Clin Anaesthesiol · Mar 2008
ReviewHaemoglobin, oxygen carriers and perioperative organ perfusion.
Under normal conditions, only 20-30% of the delivered oxygen is metabolised. In normovolaemic anaemia, the organism reacts with increases in cardiac output and oxygen extraction. Once these mechanisms are exceeded, allogeneic blood transfusions may be administered. ⋯ The main groups of artificial oxygen carriers are extracellular haemoglobin solutions and perfluorocarbons. Preparations undergoing experimental and clinical assessment include Human Polymerized Haemoglobin (Polyheme), Polymerized Bovine Haemoglobin-based Oxygen Carrier (HBOC-201, Hemopure), Haemoglobin Raffimer (HemoLink), Diaspirin Cross-linked Haemoglobin (HemAssist), Human Recombinant Haemoglobin (rHb), Enzyme Cross-linked Poly-haemoglobin, Maleimide-activated Polyethylene-glycol Modified Haemoglobin (MP4, Hemospan), Zero-linked Haemoglobin (ZL-HbBv) and Recombinant Hybrid of Human-alpha-chains and Bovine-beta-chains and Perflubron (Oxygent). Research into some of these compounds has been discontinued, while others have advanced into clinical phase III trials, but none has achieved market approval for Europe, US or Canada so far.
-
Best Pract Res Clin Anaesthesiol · Mar 2008
ReviewPharmacogenomics and end-organ susceptibility to injury in the perioperative period.
Genomic medicine has provided new mechanistic understanding for many complex diseases over the last 5-10 years. More recently genomic approaches have been applied to the perioperative paradigm, facilitating identification of patients at high risk for adverse events, as well as those who will respond better/worse to specific pharmacologic therapies. ⋯ Precise predictors of each adverse event are being elucidated so that corrective therapeutics can be instituted to improve outcomes in high-risk patients. While the field of perioperative genomics could be considered in its infancy, such approaches are the wave of the future.
-
Preserving donor organs in optimal condition is a prerequisite for successful transplantation. The donor organ is subjected to a multitude of stresses. ⋯ As progressively more is known about the underlying pathophysiological mechanisms, focused and efficient therapeutic interventions can be developed. We will review current organ protection techniques and look at possible future strategies to further improve the final donor organ quality.
-
Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury and acute respiratory distress syndrome. ⋯ Clinical research trends show that traditional protocols for perioperative mechanical ventilation, using large tidal volumes without positive end-expiratory pressure (PEEP) can cause a sub-clinical lung injury and this injury becomes clinically important when any additional lung injury is added. Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of PEEP can decrease the extent of this injury.