ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

New surgical techniques for bypassing coronary artery lesions are being explored with the goals of avoiding cardiopulmonary bypass, minimizing disfiguring scars, and decreasing hospital stay and costs. These forms of cardiac surgery have significant anesthetic implications. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. Postoperative trends towards early extubation and patient mobilization require anesthetic techniques that facilitate rapid recovery. Curr Opin Anaesthesiol 12:3-8.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This review deals with recent developments in non-invasive cardiac output measurement. In the past few years significant progress has been made with semi-invasive transoesophageal echocardiography; the method now provides advanced facilities to measure cardiac output and other important characteristics of cardiac function. The method is, however, operator-dependent and the equipment used is expensive, which means that large-scale use on intensive care patients is not feasible. Whole-body impedance cardiography has recently shown good accuracy and flexibility in use, and seems to be the most promising method for the non-invasive measurement of cardiac output. Curr Opin Anaesthesiol 12:9-13.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Prophylactic percutaneous transluminal coronary angioplasty is one revascularization strategy employed to reduce risks of cardiac complications after noncardiac surgery in certain patients. Reduced adverse cardiac event rates are at least partially offset by costs and complications of angioplasty. Patients who undergo noncardiac surgery within 90days of coronary angioplasty may be at increased risk for postoperative cardiac complications. Curr Opin Anaesthiol 12:15-20.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This review focuses on weaning from cardiopulmonary bypass, a very critical time for patients and anaesthetists and frequently requiring major therapeutic effort. Few novel strategies for weaning have been described recently. Most drugs or approaches described during the review period are already well established. Emphasis is placed on the importance of non-cardiac factors, and on the importance of diastolic ventricular function as opposed to systolic function. Curr Opin Anaesthesiol 12:21-27.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

During video-assisted thoracoscopy the lungs should be well collapsed to allow the surgeon an optimal view of the surgical field. The use of ‚difficult tubes‚ such as the double lumen tube or Univent cannot be avoided despite the presence of a difficult airway. If it is only possible to place a single lumen tube, a tube exchanger can be used to switch to a double lumen tube or a Univent tube. Alternatively, a Fogarty embolectomy catheter can be passed down the single lumen tube as an independant bronchial blocker. The Bullard and the Wu laryngoscopes and the laryngeal airway mask can further assist in establishing an airway. Finally, depending on the extent and the length of the procedure, an airway, initially not classified as difficult, may become difficult and postoperative planning is a must. Curr Opin Anaesthesiol 12:29-35.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hypoxia-induced by acute lung injury results from abnormal ventilation/perfusion ratio distribution towards shunt or low ventilation/perfusion zones. Pharmacological modification of pulmonary blood flow distribution improving ventilation/perfusion ratio should correct hypoxia. The development of inhaled nitric oxide therapy had confirmed this concept, but with a relatively high proportion of ‚non responders‚. Then development of other drugs used alone or in association with nitric oxide may reinforce the benefit of nitric oxide. This has been tested with almitrine bismesylate, a lipophilic drug that reinforce hypoxic pulmonary vasoconstriction. Using inhaled nitric oxide in combination with almitrine, several studies in adult respiratory distress syndrome or acute lung injury patients have shown spectacular results in term of PaO2and pulmonary shunt reduction. Moreover, the proportion of responders to this combination seems largely great than those observed for each drug alone. In conclusion, pulmonary blood flow manipulation improving ventilation/perfusion mismatching is one of the major strategies to correct severe hypoxia. Curr Opin Anaesthesiol 12:37-42.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hypoxic pulmonary vasoconstriction is a local reflex in the lung that diverts blood away from poorly oxygenated regions. Improvements in understanding of modulators of this response have led to pharmacologic methods whereby V/Q matching may potentially be improved in certain types of pulmonary pathology and during anesthesia for thoracic surgical procedures. Curr Opin Anaesthesiol 12:43-48.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Post-pneumonectomy pulmonary edema is a major cause of early mortality following lung resection surgery. It is not clear whether this complication is caused by excessive perioperative intravenous fluid as was previously thought. The recent demonstration of increased pulmonary capillary permeability of the lung following a pneumonectomy suggests measures to try and decrease the incidence of this highly lethal syndrome. These measures include the judicious use of intravenous crystalloids, avoidance of lung hyperinflation and efforts to minimize the pulmonary artery pressure. Curr Opin Anesthiol 12:49-54.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Publications on post-thoracotomy pain control obtained by Medline search were reviewed from June 1997 to July 1998. The main focus points in the past year were the effect of new surgical techniques on analgesia after thoracic surgery and the use of extrapleural catheters in the paravertebral space as a method of continuous intercostal nerve block. Epidural and patient-controlled analgesia techniques are still widely used and are mostly effective, but some patients may still have unacceptable levels of pain in the first 24 hours. Curr Opin Anaesthesiol 12:55-58.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID