Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2020
ReviewPreoperative management of anticoagulation in the surgical patient: Highlights of the latest guidelines.
Oral anticoagulants (OACs) are a class of medications commonly used in the long-term management of patients at risk of thrombosis. They include warfarin and direct oral anticoagulants (DOACs). The aging of the population and improvements in perioperative care have led to an increase in the number of patients on OACs and presenting for different types of elective and emergency surgery. ⋯ It is based on the quantification of a patient's individual hemorrhagic and thrombotic risk together with the intrinsic surgical bleeding risk. We reviewed current guidelines to define effective discontinuation of OACs, the need for bridging with different anticoagulants, and post-surgery OACs re-initiation. We also discussed the option for acute reversal of anticoagulation.
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Best Pract Res Clin Anaesthesiol · Jun 2020
ReviewMultiple drug allergies: Recommendations for perioperative management.
Life-threatening hypersensitivity reactions are more likely to occur in patients with a history of allergy, atopy, or asthma. Hence, in a patient who presented with a history of multiple drug allergies (MDA), an allergological assessment should be performed prior to surgical procedure. Drug allergies, being one of the causes of catastrophic events occurring in the perioperative period, are of major concern to anesthesiologists. ⋯ Allergic reactions to propofol are rare with an incidence of 1:60,000 exposures. Although intraoperative drug anaphylaxis is rare, it contributes to 4.3% of deaths occurring during general anesthesia. These recommendations discuss pathophysiology of MDA, preoperative evaluation, and anesthesia considerations as well as the prevention and management of allergic reactions in anesthetized patients with a history of MDA.
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Best Pract Res Clin Anaesthesiol · Jun 2020
ReviewPoint-of-care ultrasound in the preoperative setting.
Point-of-care ultrasound (POCUS) is a widely used diagnostic tool, especially in emergency and critical care medicine, and it is increasingly being used in the perioperative setting. Its specific role in preoperative assessment of patients, however, has not yet been defined. While some data show innovative use of the technique in the preoperative setting, higher-level evidence to underscore potential advantages is still limited. We review and discuss a range of POCUS examinations which can potentially help anaesthesiologists in the preoperative clinic decide whether to perform additional testing, can assist in selecting the best anaesthetic approach, and can support perioperative and postoperative monitoring.
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Best Pract Res Clin Anaesthesiol · Jun 2020
ReviewManaging preoperative anemia: Evolving concepts and strategies for improving patient outcomes.
Anemia is the most common hematological disease, and is defined by the World Health Organization as a condition in which the number of red blood cells and consequently oxygen-carrying capacity is insufficient to meet the physiological needs of the body. Anemia can occur throughout the perioperative period and has important clinical consequences. ⋯ Postoperative anemia is a common event and occurs in 80-90% of patients who have undergone major surgery. This manuscript discusses the detection and management of preoperative anemia, the three pillars of patient blood management, perioperative anemia management, and risk stratification for anemia in the surgical setting.