Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Sep 2007
Psychological consequences of awareness and their treatment.
Intraoperative awareness with subsequent recall is a rare but serious complication with an incidence of 0.1-0.2%. In approximately one third of the patients who have experienced awareness, late severe psychiatric sequelae may develop. The psychiatric symptoms in these patients fulfil the diagnostic criteria for post traumatic stress disorder. ⋯ The problem must be acknowledged. Professional psychiatric assessment and follow up should constitute standard practice. The treatments of choice are Eye Movement Desensitisation Reprocessing and Cognitive Behaviour Therapy.
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Episodic memory is the most 'human' of all memory systems, is integrally related to the hippocampus, and not only permits memories of the past in rich detail, but also allows projection of thoughts into the future. However, episodic memory is very sensitive to anaesthetic drugs and cannot be formed during adequate general anaesthesia. ⋯ A more detailed understanding of episodic memory in relation to other memory systems, as well as the relationship of the hippocampus to episodic memory function is provided. A synthesis of diverse knowledge is undertaken to identify potential mechanisms of amnesic drug effect, which will, of course, require further research to delineate.
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Performing a surgical procedure on a patient undergoing anti-platelet therapy raises a dilemma: is it safer to withdraw the drugs and reduce the haemorrhagic risk, or to maintain them and reduce the risk of myocardial ischaemic events? Based on recent clinical data, this review concludes that the risk of coronary thrombosis on anti-platelet drugs withdrawal is much higher than the risk of surgical bleeding when maintaining them. In secondary prevention, aspirin is a lifelong therapy and should never be stopped. Clopidogrel is mandatory as long as the coronary stents are not fully endothelialized, which takes 6-24 weeks depending on the technique used, but might be required for a longer period.
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Best Pract Res Clin Anaesthesiol · Jun 2007
ReviewAllogeneic red blood cell transfusion: physiology of oxygen transport.
Allogeneic red blood cell (RBC) transfusions have been shown to be associated with considerable risks. While their efficiency in many clinical situations has not been proven, the number of studies finding adverse outcomes in terms of morbidity (e.g. postoperative infections) and mortality continues to rise. ⋯ Only a thorough knowledge of the physiology and pathophysiology of oxygen transport can be a solid base for meaningful transfusion decisions. Therefore, the goal of this article is to review the basics of oxygen transport and normovolaemic anaemia.