Articles: postoperative.
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Curr Opin Anaesthesiol · Feb 2014
ReviewUpdate on minimally invasive hemodynamic monitoring in thoracic anesthesia.
Advanced hemodynamic monitoring is indispensable for adequate management of patients undergoing major surgery. This article will summarize minimally invasive hemodynamic monitoring technologies and their potential use in thoracic anesthesia. ⋯ Many different minimally invasive hemodynamic monitoring devices have been developed and clinically introduced in the last years. They offer the advantage of being less invasive and easier to use. However, these techniques have several limitations and data are scarce in patients undergoing thoracic anesthesia, preventing their widespread use so far.
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Curr Opin Anaesthesiol · Feb 2014
ReviewCerebral near-infrared spectroscopy in perioperative management of left ventricular assist device and extracorporeal membrane oxygenation patients.
Spinal cord ischemia after thoracoabdominal aortic interventions is a devastating complication because it significantly worsens the perioperative morbidity and mortality. Long-term outcome is also affected because of medical complications which are directly related to the neural deficits. Paraplegia has significant medical, social, and financial aspects. Limited mobility, the need for assistance in activities of daily living, makes paraplegia an important target for prevention. An understanding of spinal cord blood supply, risk factors for spinal ischemia, and strategies for spinal cord rescue in this setting can help minimize the negative outcome effects of this important complication. ⋯ The progression of spinal cord ischemia after thoracoabdominal aortic interventions can frequently be arrested before irreversible infarction results. This spinal cord rescue depends on the early detection and immediate multimodal intervention to maximize spinal cord oxygen supply. The devastating outcomes associated with spinal infarction in this setting offset the risks and knowledge gaps currently associated with contemporary interventions.
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Cerebral oximetry, though first described for clinical use in cardiac surgery, has been increasingly used in the setting of thoracic surgery. Research focusing on the use of cerebral oximetry in this setting is relatively sparse. This review outlines our current understanding of the use of cerebral oximetry for thoracic surgery. ⋯ Although it is clear that cerebral desaturation can commonly occur during thoracic surgery, it is partly dependent upon how desaturation is defined. The relationship between cerebral desaturation and adverse outcomes after thoracic surgery, as well as the potential ability for cerebral oximetry to guide therapeutic modalities, awaits much needed additional research before being more widely accepted.
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Observational Study
Pain assessment in the postanaesthesia care unit using pupillometry: A cross-sectional study after standard anaesthetic care.
Patients assess their own pain with a numerical rating scale (NRS). In the postanaesthesia care unit (PACU), NRS helps to determine and monitor analgesic administration, but is useless in patients who are unable to communicate. In non-PACU patients, acute pain increases pupillary diameter and pupillary light reflex amplitude (PLRA), the difference between pupillary diameter before and after light stimulation. ⋯ Acute postoperative pain is not associated with pupillary diameter or PLRA. Further research is required to develop tools to assess pain in the PACU.
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J Stroke Cerebrovasc Dis · Feb 2014
Case ReportsPostoperative brain stroke after shoulder arthroscopy in the lateral decubitus position.
The beach chair position is used frequently for shoulder arthroscopy surgery. However, the beach chair position has been reported to be linked to postoperative cerebral stroke. ⋯ The patient experienced a brief period of intraoperative hypotension. Physicians should be aware of this potential complication that could be irrelevant to the position used.