ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Recent findings in molecular research suggest that the outcome of cardiovascular surgery is at least partly determined by the individual patient's genetic predisposition to react to surgical trauma and extracorporal circulation. The activation of cellular as well as humoral cascades occurs in the perioperative period, and influences the extent of pro‐ and anticoagulation and proand anti‐inflammation. These events contribute to the incidence and severity of perioperative ischaemia or organ dysfunction, and thus determine adverse outcomes in patients undergoing cardiac surgery. Candidate genes that are possibly involved in the development of adverse outcomes not only consist of genes relevant to the field of coagulation and inflammation, but also genes functioning in lipid metabolism, ion channels, membrane integrity and others. Genomic variations may prove to serve as future diagnostic tools for the risk stratification of patients undergoing cardiovascular surgery. Curr Opin Anaesthesiol 15:3‐8. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Off‐pump coronary artery surgery is now performed safely and effectively without cardiopulmonary bypass. This review includes indications, approaches, anaesthetic and haemodynamic management, and compares the occurrence of postoperative complications and multiorgan dysfunction with conventional cardiac surgery. Curr Opin Anaesthesiol 15:9‐18. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Understanding normal haemostasis and the pathophysiology of its disorders is essential for providing optimal care and ensuring judicious usage of blood products, as is keeping abreast of novel therapeutic modalities in a rapidly evolving field. The growing availability of synthetic coagulation factors has (at least in the western hemisphere) helped to reduce morbidity and therapeutic complications, while expanding the indications and usage of these agents. Promising advances in gene therapy may indeed introduce a sea change in the next decade or two. Curr Opin Anaesthesiol 15:19‐25. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Beta‐blockers have emerged as one of the key therapeutic agents that can decrease cardiac morbidity and mortality. Advances in cardiac beta‐adrenergic receptor physiology and pharmacology have provided new insights into the beneficial effects of beta‐blockers in cardiovascular medicine. Although significant advances have been made, many specific questions still remain to be answered. We will review some of these developments and the current role of beta‐blockers in perioperative medicine. Curr Opin Anaesthesiol 15:27‐35. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;An explosion of technology has occurred in the last 10 years, intended to make treatment of vascular diseases less invasive. Once the exclusive domain of the interventional cardiologist and the coronary circulation, now in 2001 nearly every vascular system has been explored as a site for endovascular treatment of aneurysmal and atherosclerotic disease. This review will focus on endovascular treatment of abdominal aortic aneurysmal disease and carotid artery disease, and relevant issues for the anesthesiologist encountering these patients and procedures. Curr Opin Anaesthesiol 15:37‐44. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Mechanical ventilation is a life‐supporting process employed in the management of respiratory failure. Over the years, our understanding of the pathophysiology of lung injury has greatly improved, and has aided the technological development of ventilatory modes that are more patient ‘sensitive’ and less traumatizing to the lungs. This review will discuss the fundamental modes of mechanical ventilation, and present current concepts regarding patient‐ventilator interaction that either promote lung healing and weaning from positive pressure ventilation or delay recovery because of the injudicious use of ventilatory modalities that are incapable of meeting the ventilatory demands of the patient on a breath‐by‐breath basis. In addition, the current strategy for mechanical ventilation in acute lung injury and acute respiratory distress syndrome will be summarized. Curr Opin Anaesthesiol 15:45‐51. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Lung capillary pressure in healthy humans at rest ranges between 6 and 10 mmHg. At maximal effort or in pathophysiological conditions such as left sided heart disease or massive pulmonary vasoconstriction, for example in highaltitude pulmonary disease, capillary pressure may be markedly elevated. Increased capillary pressure directly affects transendothelial fluid dynamics and thus results in the formation of hydrostatic lung edema. Excessive pressure increases may cause capillary stress failure. Recent studies, however, suggest that the microvascular response to lung capillary hypertension is more complex. Pressure, strain and shear stress cause dysfunction of the capillary endothelium characterized by an imbalanced release of vasoactive mediators. Endothelial dysfunction evokes a multicellular response with features of vasoconstriction, inflammation, and vascular leakage, thrombosis, and remodeling. These active cellular reactions contribute to the pathophysiological process and may be specifically targeted by new therapeutic strategies. Curr Opin Anaesthesiol 15:57‐64. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

&NA;Management of severe pulmonary contusion is a challenge for clinicians. The incidence of adult respiratory distress syndrome (5‐20%), pneumonia (5‐50%), and mortality (5‐10%) associated with traumatic lung injury has changed little in the past three decades. Therapeutic options are limited to basic supportive measures such as mechanical ventilation, positive end expiratory pressure, invasive cardiopulmonary monitoring, analgesics and aggressive pulmonary hygiene. Presently, no pharmacological agents can prevent the progressive respiratory embarrassment that is associated with the natural history of the disease, but several drugs have been tested in the laboratory. The purpose of this brief review is to summarize information published since January 2000 related to the clinical management and pathophysiology of lung contusion. Curr Opin Anaesthesiol 15:65‐68. © 2002 Lippincott Williams & Wilkins.

ISSN:0952-7907    

出版商:OVID    

年代:2002

数据来源: OVID