Should fluid management in thoracic surgery be goal directed?
Purpose of review To find a reliable answer to the question in the title: Should fluid management in thoracic surgery be goal directed? Recent findings ’Moderate’ fluid regimen is the current recommendation of fluid management in thoracic anesthesia, however, especially in more risky patients; ’Goal-Directed Therapy’ (GDT) can be a more reliable approach than just ’moderate’. There are numerous studies examining its effects in general anesthesia; albeit mostly retrospective and very heterogenic. There are few studies of GDT in thoracic anesthesia with similar drawbacks. Summary Although the ev...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Torsten Loop Source Type: research

Anesthesia for interventional pulmonology
This article discusses recent innovations and the implications for periinterventional anesthetic management. Recent findings Interventional pulmonology is a rapidly expanding specialty with very complex diagnostic and therapeutic approaches that include oncological staging, treatment of obstructive and restrictive lung diseases, recanalization of endobronchial obstructions, and retrieval of foreign bodies. With the development of advanced diagnostic and therapeutic interventions, the application is extended to critically ill patients. Current evidence focusing on the anesthetic techniques is presented here. Summa...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Torsten Loop Source Type: research

Anesthesia for tracheal and carinal resection and reconstruction
Purpose of review The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction. Recent findings In addition to the traditional anesthetic approach using conventional tracheal intubation after induction of general anesthesia and cross-field intubation or jet-ventilation once the airway has been surgically opened, there is a trend toward less invasive anesthetic procedures. Regional anesthetic techniques and approaches focusing on the maintenance of spontaneous respiration have emerged. Especially for cervical tracheal stenosis, laryngeal ma...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Torsten Loop Source Type: research

How to train thoracic anesthesia for residents and consultants?
Purpose of review The training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied. In this review, we will show how professional curricula should aim for competence rather than number of cases and why simulation-based training and debriefing should be implemented. Recent findings Recent curricula recommend so-called entrustable professional a...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Torsten Loop Source Type: research

Preoperative evaluation in thoracic surgery: limits of the patient's functional operability and consequence for perioperative anaesthesiologic management
Purpose of review Preoperative evaluation of older and more morbid patients in thoracic surgery is getting more advanced. In this context, early risk stratification has a crucial role for adequate informed decision-making, and thus for generating favourable effects of clinical outcome. Recent findings Recent findings confirm that many risk factors impair mortality and morbidity beyond classical medical findings like results of lung function tests and values of the revised cardiac risk index. Especially results from holistic views on patients’ functional status like frailty assessments are linked with long-term...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Torsten Loop Source Type: research

Editorial: Thoracic anesthesia – developments, current trends, and key recommendations
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Torsten Loop Source Type: research

Frailty and cardiac surgery: to operate or not?
Purpose of review With an aging cardiac surgery population, prefrail and frail patients are becoming more common. Anesthesiologists will be faced with the decision of how best to provide care to frail patients. Identification, management, and outcomes in frail patients will be discussed in this review. Recent findings Frailty is associated with a variety of poor outcomes, such as increased hospital length of stay, medical resource utilization, readmission rates, and mortality. Prehabilitation may play a greater role in the management of frail cardiac surgery patients. Summary As frailty will likely only i...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Donation after cardiac death in heart transplantation: is there an ethical dilemma?
Purpose of review In an attempt to address the organ shortages in heart transplantation, USA centres have begun utilizing donation after cardiac death (DCD) as an alternative to traditional donation after brain death (DBD). As this paradigm continues to expand, there is a need to address the medico-legal and ethical aspects of DCD donation, which is the focus of the current review. Recent findings Current protocols use criteria established by the Uniform Determination of Death Act (UDDA), which is explicit in defining the irreversibility of circulation and brain function in determining death. By the nature of DC...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Critically appraising the 2018 United Network for Organ Sharing donor allocation policy: adding life boats or rearranging the deck chairs?
Purpose of review Due to the growing mismatch between donor supply and demand as well as unacceptably high transplant waitlist mortality, the heart organ allocation system was revised in October 2018. This review gives an overview of the changes in the new heart organ allocation system and its impact on heart transplant practice and outcomes in the United States. Recent findings The 2018 heart allocation system offers a 6-tiered policy and therefore prioritizes the sickest patients on the transplant waitlist. Patients supported with temporary mechanical circulatory support devices are prioritized as Status 1 or ...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Prothrombin complex concentrates in cardiac surgery: where are we?
Purpose of review Major bleeding in cardiac surgery is commonly encountered, and, until recently, most frequently managed with fresh frozen plasma (FFP). However, a Cochrane review found this practice to be associated with a significant increase in red blood cell (RBC) transfusions and costs. These findings have led to off-label uses of prothrombin complex concentrates (PCCs) in cardiac surgery. The purpose of this review is to compare and contrast the use of FFP and PCC, review the components, limitations and risks of different types of PCCs, and discuss the latest evidence for the use of PCC versus FFP in cardiac sur...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Inhalational or total intravenous anesthetic for cardiac surgery: does the debate even exist?
Purpose of review Perioperative myocardial injury related to cardiac surgery is associated with organ dysfunction and increased mortality. Volatile anesthetics (VA) have been used during cardiac surgery for decades because of their direct and indirect preconditioning and protection against ischemia-reperfusion injury. The current review provides a summary of the latest literature comparing pharmacological preconditioning and the potential benefits of using VA versus total intravenous anesthesia (TIVA) for general anesthesia to improve outcomes after cardiac surgery. Recent findings Recent literature reports lowe...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Ventricular assist device for Fontan: who, when and why?
Purpose of review Since the advent of the Fontan palliation, survival of patients with univentricular congenital heart disease has increased significantly. These patients will, however, ultimately develop heart failure requiring advanced therapies such as heart transplantation. As wait times are long, mechanical circulatory support (MCS) is an attractive therapy, both for bridge to transplantation and destination therapy in patients not suitable for transplantation. This review aims to summarize current thinking about how to determine which patients would benefit from a ventricular assist device (VAD), the optimal time...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Coronavirus disease 2019 and cardiovascular diseases: collateral damage?
Purpose of review Cardiovascular involvement in coronavirus disease 2019 (COVID-19) is relatively common and portends an increased risk of morbidity and mortality. Manifestations of myocardial injury may exhibit significant overlap and result in diagnostic uncertainty. This review will summarize recent literature around cardiovascular complications of COVID-19. Recent findings Venous thromboembolism, atrial fibrillation, and type II myocardial infarction are observed commonly in COVID-19, while severe acute respiratory syndrome coronavirus 2 viral myocarditis remains quite rare. Although infrequent, COVID-19 vac...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Editorial: cardiovascular anaesthesiology
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Nirvik Pal Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research