Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2012
ReviewRight ventricular failure after LVAD implantation: prevention and treatment.
Right ventricular failure (RVF) complicates 20-50% of left ventricular assist device (LVAD) implantation cases and contributes to increased postoperative morbidity and mortality. Normal LVAD function alters the highly compliant right ventricular (RV) physiology, which may unmask RVF. ⋯ Treatment of RVF relies on inotropic support, decreasing pulmonary vascular resistance and adjusting LVAD flows to minimise distortion of RV geometry. RVAD insertion is a last recourse when RVF is refractory to medical treatment.
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Best Pract Res Clin Anaesthesiol · Jun 2012
ReviewMechanical circulatory support for cardiogenic shock.
Cardiogenic shock (CS) is a syndrome of progressive depression of myocardial function with systemic hypoperfusion. It occurs due to various aetiologies such as acute myocardial infarction, myocarditis, acute decompensated heart failure and postcardiotomy. Cardiogenic shock carries poor prognosis, and medical therapy alone is not effective. ⋯ Currently, there are several methods of mechanical circulatory support. These include extracorporeal life support, paracorporeal or extracorporeal ventricular-assist devices, percutaneous ventricular assist devices, intra-aortic balloon counterpulsation and total artificial heart. In this review, we discuss the role of each of these circulatory support devices in the management of acute cardiac failure.
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The last 20 years has seen many changes in medical education, with reforms taking place in undergraduate health-care studies with the application of the Bologna principles and also transfer of the same educational principles to postgraduate medical specialty training. It is the aim of this article to grossly sketch and contextualise these reforms in the rapidly evolving European Union, before defining harmonisation of the medical postgraduate training and the bodies involved in this process; thereafter, the authors try to present the potential consensus points that can make the process of harmonisation in anaesthesiology postgraduate training in Europe become a reality. Finally, a brief outline of the potential challenges concludes the paper.
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Best Pract Res Clin Anaesthesiol · Mar 2012
Pre-anaesthesia residency requirements: what provides a solid foundation?
The specialty of anaesthesiology has expanded from the intra-operative management of the surgical patient undergoing an operative procedure to the perioperative management of patients undergoing procedures. The perioperative management involves the preoperative evaluation and preparation and also involves the postoperative management of the patient. To effectively perform these functions, a solid foundation in cardiology, pulmonary Medicine, critical care Medicine and pain medicine is mandatory. After completing the required courses in medical school, electives in these areas will prepare the student for further training in anaesthesiology.