Articles: postoperative.
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This article reviews the use of noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), with a critical review of the most recent literature in this setting. ⋯ Although patients with severe hypoxemic ARF are, in general, less likely to be intubated when NIV is used, the efficacy is different among these heterogeneous populations. Therefore, NIV is not routinely recommended in all patients with severe hypoxemic ARF.
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Curr Opin Anaesthesiol · Feb 2015
ReviewTransesophageal echocardiography in thoracic anesthesia: pulmonary hypertension and right ventricular function.
Pulmonary hypertension is associated with increased postoperative morbidity and mortality. Early diagnosis and echocardiographic detection of right ventricular (RV) dysfunction are paramount in perioperative management. The goal of this review is to provide an overview of the recent literature on this topic. ⋯ More pulmonary hypertension patients are presenting for noncardiac surgery, creating a challenge for the anesthesiologist. Echocardiographic detection of RV dysfunction can be difficult. Routine use of intraoperative transesophageal echocardiography in major thoracic surgery is not advocated yet, but the development of automated techniques may provide an objective assessment of RV function.
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The aim of this study was to explore the nociceptive system of patients affected by trigeminal neuralgia (TN) secondary to documented vascular contact who underwent microvascular decompression. For that purpose, we used the classical trigeminal reflexes and the trigeminal laser-evoked potentials (tLEPs) before and after surgery, in order to verify any possible change after decompression and determine if there was any correlation between the neurophysiological parameters and the clinical outcome. ⋯ This study demonstrates that TN caused by trigeminovascular compression may be related to Aδ fibres impairment, and tLEPs are more sensitive than conventional trigeminal reflexes to reveal small fibre dysfunction and to monitor the post-surgical outcome in these patients.
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J Clin Monit Comput · Feb 2015
Randomized Controlled TrialContinuous non-invasive monitoring improves blood pressure stability in upright position: randomized controlled trial.
Intermittent blood pressure (BP) monitoring is the standard-of-care during low and intermediate risk anaesthesia, yet it could lead to delayed recognition of BP fluctuations. Perioperative hypotension is known to be associated with postoperative complications. Continuous, non-invasive methods for BP monitoring have been developed recently. ⋯ No significant differences were observed in postoperative morbidity or in hospital length of stay. Continuous non-invasive BP monitoring via the CNAP® Monitor allows for better BP management in patients undergoing surgery in a beach chair position. In our randomised trial the time spent in hypotension was significantly shorter using continuous monitoring.
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Enhanced Recovery After Surgery (ERAS) programs have increasingly attracted the attention of clinicians who are intent on minimizing postoperative morbidity, decreasing variability in surgical care, and containing hospital costs. The purpose of this review is to discuss the relevant pathophysiology of the surgical stress response and its associated mechanisms that regulate important metabolic changes. ⋯ The implementation of a targeted ERAS program has been shown to modulate perioperative insulin sensitivity, thus improving postoperative outcomes and accelerating the return of baseline function.