Levosimendan: What Have We Learned So Far?
AbstractPurpose of ReviewVasoactive therapy represents a pivotal yet debated topic in critically ill patients and in those with chronic heart failure. Levosimendan, a calcium sensitizer agent with inodilating properties, has been in the market for 27 years and new indications came out over time. The aim of the present review is to highlight what is actually proven and what is debated on the use of levosimendan in light of its pharmacologic features and the pathophysiological evidence.Recent FindingsLevosimendan was firstly seen as an inodilator acting through calcium sensitization in myocytes both in the myocardium and i...
Source: Current Anesthesiology Reports - July 9, 2019 Category: Anesthesiology Source Type: research
Neurological Complications in Cardiac Surgery
AbstractPurpose of ReviewPerioperative neurological complications have a significant impact on mortality, morbidity, and quality of life in a growing number of high-risk patients undergoing cardiac surgery. In this comprehensive review, we provide an outline of the current literature with regard to stroke, perioperative neurocognitive disorders (delirium and cognitive decline), postoperative visual loss, and peripheral nerve injury in cardiac surgery.Recent FindingsCardiac surgeons, anesthesiologists, and critical care specialists are facing a new population of cardiosurgical patients who are older and sicker than in previ...
Source: Current Anesthesiology Reports - July 3, 2019 Category: Anesthesiology Source Type: research
Perioperative Multimodal Pain Management: an Evidence-Based Update
AbstractPurpose of reviewThe purpose of this article is to provide a concise review of recent updates and ongoing controversies in perioperative multimodal analgesia with a specific focus on systemic pharmacologic options.Recent findingsAcetaminophen, non-steroidal anti-inflammatory drugs, and ketamine provide clear benefit for analgesia and opioid sparing, with wide safety margins at clinically relevant doses. Enthusiasm is waning for the use of gabapentinoids (gabapentin and pregabalin) and systemic alpha-2 agonists (clonidine and dexmedetomidine) due to small benefit and a potentially dangerous side effect profile (seda...
Source: Current Anesthesiology Reports - July 2, 2019 Category: Anesthesiology Source Type: research
Pecs and Serratus Blocks: Current State of Chest Wall Analgesia
This article seeks to provide a current review of pertinent literature with regards to analgesia for chest wall surgery —specifically Pecs and serratus blocks.Recent FindingsIntermuscular plane blocks have been shown to be clinically efficacious in the setting of chest wall surgery, especially in the setting of oncologic breast surgery.SummaryPecs and serratus blocks provide a safe and effective alternative to neuraxial analgesia while avoiding many of the associated technical difficulties and potential complications. (Source: Current Anesthesiology Reports)
Source: Current Anesthesiology Reports - July 2, 2019 Category: Anesthesiology Source Type: research
From the Physiology to the Bedside: Fluid Therapy in Cardiac Surgery and the ICU
AbstractPurpose of ReviewIn this review, we summarize the evidence present in the literature about this important field, with particular attention to the peculiarities of cardiac surgery.Recent FindingsSince water is the main component of human cells and tissue, together with electrolytes and proteins, the manipulation of this element in critical illness is a powerful tool in the hands of the anesthesiologist and intensive care doctor. It can be either extraordinarily effective in the treatment of the patient ’s disease and in correcting the hemodynamic instability or it can lead to very dangerous consequences, such as e...
Source: Current Anesthesiology Reports - July 2, 2019 Category: Anesthesiology Source Type: research
