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Current Opinion in Anaesthesiology

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https://www.readbyqxmd.com/read/27906721/preoperative-evaluation-and-preparation-of-the-morbidly-obese-patient
#1
Andreas B Böhmer, Frank Wappler
PURPOSE OF REVIEW: This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. RECENT FINDINGS: Preoperative evaluation should be carried out with sufficient time before the day of surgery to allow modification of the perioperative management...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906720/decisions-regarding-forgoing-life-sustaining-treatments
#2
Gail A Van Norman
PURPOSE OF REVIEW: Decisions to forego life-sustaining treatments are complex, and disagreements between physicians and patients occur. This review discusses recent findings regarding what factors influence physicians and patients or their surrogates in these decisions and considers whether futility arguments regarding life-sustaining treatments should be abandoned. RECENT FINDINGS: Cardiopulmonary resuscitation is one paradigm in the literature for studying end-of-life decision-making...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906719/diagnosis-of-cardiac-surgery-associated-acute-kidney-injury-from-functional-to-damage-biomarkers
#3
Wim Vandenberghe, Jorien De Loor, Eric A J Hoste
PURPOSE OF REVIEW: Acute kidney injury (AKI) occurs in up to 30% after cardiac surgery and is associated with adverse outcome. Currently, cardiac surgery-associated acute kidney injury (CSA-AKI) is diagnosed by Kidney Disease: Improving Global Outcomes criteria based on creatinine and urine output. To detect and treat AKI earlier, various biomarkers have been evaluated. This review addresses the current position of the two damage biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and [TIMP-2] [IGFBP7] in clinical practice...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906718/anesthesia-for-nonintubated-video-assisted-thoracic-surgery
#4
Hiroshi Sunaga, Justin D Blasberg, Paul M Heerdt
PURPOSE OF REVIEW: This review focuses primarily on nonintubated video-assisted thoracic surgery (NIVATS), and discusses advantages, indications, anesthetic techniques, and approaches to intraoperative crisis management. RECENT FINDINGS: Advancements in endoscopic, endovascular, and robotic techniques have expanded the range of surgical procedures that can be performed in a minimally invasive fashion. For thoracic operations in particular, video-assisted thoracic surgery (VATS) has largely replaced traditional thoracotomy, and continued technical development has made surgical access into the pleural space even less disruptive...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27906717/spectrum-of-postoperative-complications-in-pulmonary-hypertension-and-obesity-hypoventilation-syndrome
#5
Roop K Kaw
PURPOSE OF REVIEW: The purpose of this review is to identify chronic pulmonary conditions which may often not be recognized preoperatively especially before elective noncardiac surgery and which carry the highest risk of perioperative morbidity and mortality. RECENT FINDINGS: This review discusses some of the most recent studies that highlight the perioperative complications, and their prevention and management strategies. SUMMARY: Pulmonary hypertension is a well recognized risk factor for postoperative complications after cardiac surgery but the literature surrounding noncardiac surgery is sparse...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27898431/improving-outcome-of-trauma-patients-by-implementing-patient-blood-management
#6
Christoph Füllenbach, Kai Zacharowski, Patrick Meybohm
PURPOSE OF REVIEW: Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. RECENT FINDINGS: Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy...
November 24, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27898430/an-update-on-the-various-practical-applications-of-the-stop-bang-questionnaire-in-anesthesia-surgery-and-perioperative-medicine
#7
Mahesh Nagappa, Jean Wong, Mandeep Singh, David T Wong, Frances Chung
PURPOSE OF REVIEW: The present review aims to provide an update on the various practical applications of the STOP-Bang questionnaire in anesthesia, surgery, and perioperative medicine. RECENT FINDINGS: The STOP-Bang questionnaire was originally validated as a screening tool to identify surgical patients who are at high-risk of obstructive sleep apnea (OSA). A recent meta-analysis confirmed that STOP-Bang is validated for use in the sleep clinic, surgical, and general population...
November 24, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27875367/cardiac-surgery-associated-acute-kidney-injury-much-improved-but-still-long-ways-to-go
#8
Alexander Zarbock
No abstract text is available yet for this article.
November 21, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27841788/mortality-and-cost-of-acute-and-chronic-kidney-disease-after-cardiac-surgery
#9
Nicholas Lysak, Azra Bihorac, Charles Hobson
PURPOSE OF REVIEW: Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. RECENT FINDINGS: Both AKI and CKD increase the risk for short-term and long-term mortalities, morbidity, length of stay, and hospital cost among postoperative patients, with increasing disease stage correlating with worse outcomes...
November 10, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27841787/therapy-of-acute-kidney-injury-in-the-perioperative-setting
#10
Stefano Romagnoli, Zaccaria Ricci, Claudio Ronco
PURPOSE OF REVIEW: The current review analyzes the current pharmacologic approaches in cardiac surgery-associated acute kidney injury and renal replacement/support therapies. RECENT FINDINGS: Hemodynamic management and promising therapies, including atrial natriuretic peptide, calcium sensitizer inodilators, and mesenchymal stem cells have been discussed. Encouraging results from pre-emptive renal replacement therapies have been also addressed. SUMMARY: Cardiac surgery is responsible for the highest risk of renal dysfunction with respect to other surgical settings...
November 10, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27820742/epidemiology-and-pathophysiology-of-cardiac-surgery-associated-acute-kidney-injury
#11
Dana Y Fuhrman, John A Kellum
PURPOSE OF REVIEW: Acute kidney injury (AKI) remains a serious complication of cardiac surgery. An understanding of the epidemiology and pathophysiology of AKI in cardiac surgery patients is crucial to early recognition and proper management. RECENT FINDINGS: The article will review the current criteria used for defining AKI and the most recently published incidence rates of AKI in the cardiac surgery population. Variables associated with AKI will be reviewed. The cause of cardiac surgery-associated AKI is multifactorial involving genetic factors as well as insults because of nephrotoxins, ischemia and reperfusion, cardiac dysfunction, venous congestion, inflammation, and oxidative stress...
November 4, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27820741/does-fluid-management-affect-the-occurrence-of-acute-kidney-injury
#12
Johan Mårtensson, Rinaldo Bellomo
PURPOSE OF REVIEW: To describe the potential impact of different fluid management strategies on renal outcomes in critically ill and postoperative patients. RECENT FINDINGS: Uncritical fluid administration may induce renal compartment syndrome and renal venous congestion, which contribute to kidney dysfunction. In more than 5000 randomized surgical or septic patients, goal-directed therapy did not reduce fluid accumulation, acute kidney injury (AKI) development or need for renal replacement therapy...
November 4, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27820740/enhanced-recovery-after-bariatric-surgery
#13
Adrian Alvarez, Basavana G Goudra, Preet Mohinder Singh
PURPOSE OF REVIEW: Enhanced recovery after surgery (ERAS) methodology has demonstrated consistent benefits in patients undergoing colorectal, urological and thoracic surgeries. Principles of these protocols and their advantages are expected to extend into other surgical specialties such as bariatric surgery. In this review, we summarize the components of ERAS protocols for bariatric surgery and present the evidence on the emerging role of ERAS principles in obese patients. RECENT FINDINGS: Many recent trials have evaluated ERAS protocols for bariatric surgery...
November 4, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27792079/obesity-hypoventilation-syndrome-sleep-apnea-overlap-syndrome-perioperative-management-to-prevent-complications
#14
Raviraj Raveendran, Jean Wong, Mandeep Singh, David T Wong, Frances Chung
PURPOSE OF REVIEW: The prevalence of sleep disordered breathing (SDB) is increasing proportional to the prevalence of obesity. Although anesthesiologists are familiar with obstructive sleep apnea (OSA) - the most common SDB, anesthesiologists may not be aware of other SDB such as obesity hypoventilation syndrome (OHS) and overlap syndrome (combination of OSA and chronic obstructive pulmonary disease). The present review provides an update of information regarding the perioperative management of OHS and overlap syndrome...
October 26, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27792078/extracorporeal-lung-support
#15
Michael Salna, Matthew Bacchetta
PURPOSE OF REVIEW: The applications for extracorporeal membrane oxygenation for lung support are constantly evolving. This review highlights fundamental concepts in extracorporeal lung support and describes directions for future research. RECENT FINDINGS: Since the 1950s, extracorporeal lung support has experienced continuous advancements in circuit design and safety in acute respiratory distress syndrome, chronic obstructive pulmonary disease exacerbations, as a bridge to transplantation, intraoperative cardiopulmonary support, and for transportation to referral centers...
October 26, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27792077/sleep-sleep-studies-and-sleep-disordered-breathing-basic-knowledge-for-the-anesthesiologist
#16
Andrew P Hall
PURPOSE OF REVIEW: To provide a basic understanding of sleep physiology, the pathophysiology of sleep-disordered breathing and the processes applied in undertaking and assessing sleep studies. RECENT FINDINGS: It has become increasingly apparent that obstructive sleep apnoea is associated with heightened perioperative risk. Furthermore, the condition still remains under-diagnosed in patients presenting for surgery. SUMMARY: This review describes the physiology of sleep including sleep stages, sleep monitoring, the normal hypnogram and investigation from simple overnight pulse oximetry to full polysomnography...
October 26, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27783023/single-lung-ventilation-and-oxidative-stress-a-different-perspective-on-a-common-practice
#17
Paul M Heerdt, David F Stowe
PURPOSE OF REVIEW: To summarize what is currently known about the relationship between single-lung ventilation (SLV), oxidative stress, and postoperative disruption of organ function. RECENT FINDINGS: SLV produces progressive alelectasis that is associated with hypoxic pulmonary vasoconstriction and redistribution of blood flow away from the nonventilated lung. This local tissue hypoxia induces the generation of reactive oxygen and reactive nitrogen species, an effect subsequently amplified by lung re-expansion consistent with well described hypoxia/reperfusion responses...
October 25, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27783022/new-trends-in-interventional-pulmonology
#18
Angela Roberts Selzer, Matthew Murrell, Eugene Shostak
PURPOSE OF REVIEW: As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications. RECENT FINDINGS: The scope of the interventional pulmonologist's practice is varied and includes both diagnostic and therapeutic procedures...
October 25, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27764049/current-trends-in-anesthesia-for-esophagectomy
#19
Chris Durkin, Travis Schisler, Jens Lohser
PURPOSE OF REVIEW: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection...
October 18, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27748669/congenital-heart-surgery-and-acute-kidney-injury
#20
Tennille N Webb, Stuart L Goldstein
PURPOSE OF REVIEW: The incidence of cardiac surgery-associated acute kidney injury (CS-AKI) continues to increase and is associated with significant morbidity and mortality. Early diagnosis and identification of patients at risk are extremely important. Therefore, identifying associated risk factors, biomarkers for earlier detection, prevention and therapeutic options for CS-AKI warrant special attention. RECENT FINDINGS: The current diagnosis of acute kidney injury (AKI) largely depends upon the functional biomarkers serum creatinine and oliguria leading to delays in diagnosis and worsening outcomes...
September 29, 2016: Current Opinion in Anaesthesiology
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