Pulmonary Hypertension and Thoracic Surgery: Impact and Treatment Options
AbstractPurpose of ReviewThe purpose of this paper is to review updates to the definition of pulmonary hypertension (PH), its diagnosis, and management. New treatment options, the role of mechanical support, outcome studies, and intraoperative management will be emphasized.Recent FindingsThe definition of PH has been recently changed, with a decrease in the qualifying mean pulmonary artery pressure and the addition of pulmonary vascular resistance. There have been minor changes to PH classifications. Some new medications are available to treat PH, and new associations between drugs and PH have been discovered. Recommended ...
Source: Current Anesthesiology Reports - November 10, 2019 Category: Anesthesiology Source Type: research
Perioperative Management of Delirium in Geriatric Patients
AbstractPurpose of ReviewWe review the current literature on predictors, pathophysiology, and prevention of delirium in surgical patients. The focus is on the role of the anesthesiologist in the prevention and management of delirium in the perioperative setting.Recent FindingsRecent literature has examined how surgery and anesthetic management can affect the incidence of delirium. Anesthesiologists play a critical role in identifying those at risk of developing delirium and adjusting their anesthetic management and perioperative course to minimize this risk.SummaryDelirium research is evolving rapidly. Current evidence sug...
Source: Current Anesthesiology Reports - November 10, 2019 Category: Anesthesiology Source Type: research
Hypoxemia During One-Lung Ventilation: Does it Really Matter?
AbstractPurpose of ReviewThe human system of oxygen transport and metabolism is complex, and appropriate means to follow its single steps intraoperatively do not exist. Intraoperative tissue hypoxia is one of the leading dangers for patients receiving one-lung ventilation (OLV). Pulmonary, cerebral, or cardiac injuries may be the result. To summarize the current knowledge about the tolerable human limits of hypoxia, inside and outside the thoracic surgery room, is the purpose of this review.Recent FindingsHigh altitude mountaineers and apnea divers teach us that the healthy human body is able to acclimatize to and cope wit...
Source: Current Anesthesiology Reports - November 6, 2019 Category: Anesthesiology Source Type: research
The Challenge of Perioperative Fluid Management in Elderly Patients
AbstractPurpose of ReviewThe purpose of this chapter is to describe physiological changes occurring with age relevant to fluid therapy, and to discuss the influence of fluid therapy on outcome of surgery from this perspective.Recent FindingsDehydration, common among elderly people, is often mistaken for dementia or depression. Dehydration with dizziness increases the risk of falling, a predictor for adverse outcomes after surgery.Young volunteers can excrete up to 300 mmol sodium per liter urine. Elderly people cannot achieve such a concentration emphasizing the importance of giving water to excrete the osmoles given with ...
Source: Current Anesthesiology Reports - October 30, 2019 Category: Anesthesiology Source Type: research
Emergency General Surgery in Older Patients: Where Are We Now?
AbstractPurpose of ReviewThe purpose of this chapter is to provide a review of the literature around emergency general surgery in older patients.Recent FindingsEmergency general surgery has a high mortality rate and with the population ageing at an unprecedented rate, older patients have an increased mortality risk due to their age alone. Complications are higher and older patients are more likely not to be discharged home following surgery. However, accurately predicting risk of surgery in elderly patients is very difficult. Simple measures such as concurrent comprehensive geriatric assessment with surgical assessment may...
Source: Current Anesthesiology Reports - October 29, 2019 Category: Anesthesiology Source Type: research
Which Anesthesia Regimen Should Be Used for Lung Surgery?
AbstractPurpose of ReviewThe aim of this review is to assess the particularities of general anesthesia for patients undergoing lung surgery and one-lung ventilation (OLV), and to suggest the ideal anesthesia regimen based on the current literature.Recent FindingsPulmonary surgery is often performed using OLV. This is accompanied by specific physiological challenges and risks, principally hypoxemia and acute lung injury (ALI). Anesthetic strategies to prevent ALI include close adjustment of mechanical ventilation settings using low tidal volumes (< 6 ml/kg for OLV), positive end-expiratory pressure between 5 and 10 cmH2O...
Source: Current Anesthesiology Reports - October 27, 2019 Category: Anesthesiology Source Type: research
Serratus Plane Block in the Management of Post-operative Thoracotomy Pain
AbstractPurpose of ReviewThoracotomy surgeries are associated with severe pain in the post-operative period; inadequate control of this pain may give rise to pulmonary complications in the form of lung atelectasis and infection. Presently, regional analgesic techniques are the mainstay therapeutic measures suggested for the management of post-operative pain after thoracotomy.Recent FindingsSerratus anterior plane block has shown good pain relief after thoracotomy and thoracoscopy procedures in many clinical trials and case reports. It involves local anesthetic injection in a plane superficial or deep to the serratus anteri...
Source: Current Anesthesiology Reports - October 27, 2019 Category: Anesthesiology Source Type: research
Transversus Abdominis Plane (TAP) and Rectus Sheath Blocks: a Technical Description and Evidence Review
This article aims to review the anatomy relevant to the ultrasound techniques of the transversus abdominis plane (TAP) block and rectus sheath block (RSB). We discuss their analgesic efficacy for various surgical procedures, both as single shot and as a continuous infusion via catheters.Recent FindingsRSB provides superior analgesia to local infiltration and has an opioid-sparing effect for umbilical surgery, laparotomy, and laparoscopic surgery. There is no high-quality evidence comparing RSB with epidural analgesia. Intermittent bolus through catheters appears to be more effective than continuous infusion for prolonged a...
Source: Current Anesthesiology Reports - October 24, 2019 Category: Anesthesiology Source Type: research
Perioperative Acute Care of Older Patients Living with Frailty
AbstractPurpose of ReviewFrailty has been independently linked to adverse postoperative outcomes including increased morbidity, mortality, health resource use, and disability. We discuss the data underlying these associations, as well as literature supporting perioperative frailty assessment and perioperative management strategies, with a focus on older people with frailty undergoing elective, non-cardiac surgery.Recent FindingsPerioperative interventions tested to improve outcomes for older people with frailty are limited; interventions proven to improve outcomes are even more rare. Current evidence-based strategies inclu...
Source: Current Anesthesiology Reports - October 23, 2019 Category: Anesthesiology Source Type: research
Positive End-Expiratory Pressure (PEEP), Tidal Volume, or Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation?
AbstractPurpose of ReviewThis review attempts to focus on protective ventilation approaches during one-lung ventilation (OLV) and will summarize recent findings.Recent FindingsRecent studies have demonstrated the importance of low tidal volume (low TV) and reduced driving pressure during OLV. Along with low TV, correct use of positive end-expiratory pressure (PEEP) seems to have a vital role in terms of protecting the ventilated lung. PEEP decremental trial and the use of electrical impedance tomography are prominent techniques for individualizing the PEEP. The use of alveolar recruitment maneuvers (ARMs) is furthermore re...
Source: Current Anesthesiology Reports - October 23, 2019 Category: Anesthesiology Source Type: research
Pediatric Palliative Care in the Perioperative Period
AbstractPurpose of ReviewThe purpose of this review is to familiarize anesthesiologists with the role of the subspecialty of pediatric palliative care and its potential contributions to the management of children with complex and life-threatening illnesses, many of whom may present for operative or diagnostic procedures requiring anesthesia.Recent FindingsRecent publications highlight the benefits of palliative care to patients and families experiencing a wide variety of conditions along the continuum from prenatal application to the management of young adults. Retrospective reports highlight improved quality of life, impr...
Source: Current Anesthesiology Reports - July 26, 2019 Category: Anesthesiology Source Type: research
Experimental Data on the Pulmonary Effects of Remote Ischemic Preconditioning
AbstractPurpose of ReviewRemote ischemic preconditioning (RIP) has been demonstrated to protect against ischemia-reperfusion-injury in different target organs. The mechanisms that eventually lead to these protective effects have been investigated in depth but are not yet fully elucidated. Although the effects of RIP seem to be promising in animal experiments and smaller clinical studies, they failed to achieve clinical significance in multicenter trials. These trials have mainly focused on the heart, the brain, and the kidneys, but only little is known concerning the effects of RIP on the lungs. This review will provide an...
Source: Current Anesthesiology Reports - July 18, 2019 Category: Anesthesiology Source Type: research
Echocardiography in the Intensive Care Unit
AbstractPurpose of ReviewThis review illustrates the incremental value of echocardiography as a bedsite tool for diagnosis and monitoring in critically ill patients with cardiopulmonary dysfunction. It provides practical guidance on the use of basic echocardiography in clinical scenarios frequently encountered in the ICU.Recent FindingsEchocardiography has become readily accessible to critical care physicians now and equipment is even been designed specifically for use in acute and critical care environments. The most important barrier to a more widespread implementation of this technique today, however, is the lack of tra...
Source: Current Anesthesiology Reports - July 17, 2019 Category: Anesthesiology Source Type: research
Metabolic Disorders and Anesthesia
AbstractPurpose of ReviewMetabolic disorders encompass a group of inherited inborn errors of metabolism that are uncommonly encountered but can pose challenges when encountered during the perioperative period. Hence, it is paramount that anesthesiologists are experienced and familiar with management of these conditions.Recent FindingsHundreds of inborn errors of metabolism have already been identified, yet new metabolic disorders continue to be discovered with advancements in genomic science.SummaryIn our general review, we define the more common metabolic disorders encountered in perioperative medicine and discuss the per...
Source: Current Anesthesiology Reports - July 11, 2019 Category: Anesthesiology Source Type: research
Speckle Tracking Strain Echocardiography: On Its Way into the Operating Room
AbstractPurpose of ReviewThe purpose of this review is to introduce the basic concepts of strain as well as its applicability to intraoperative echocardiography.Recent FindingsIn the operating room, strain literature is in its infancy. The majority of the strain literature is based on TTE studies. Currently, there are no published guidelines on the normal values of strain with TEE. Early strain literature has shown there is correlation between TTE and TEE values. Reduction in intraoperative left ventricular strain with TEE has been shown to be an independent predictor of prolonged hospitalization, postoperative atrial fibr...
Source: Current Anesthesiology Reports - July 9, 2019 Category: Anesthesiology Source Type: research
