Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.10.001
James P. Isbister
Patient Blood Management evolved in recent years, focusing on the haematopoietic system as relevant to all disciplines of medicine. The allogeneic blood supply chain travels from donation, to fractionation, preservation, and storage, to therapeutic, established treatments, or prophylactics for a wide range of medical conditions. This supply chain ‘connects’ altruistic blood donors to patients in need, symbolising a ‘gift relationship’, emphasising the empathetic bond between donor and recipient.
In 1988, the author proposed a paradigm shift in blood transfusion and, in 2005, introduced the term Patient Blood Management (PBM). PBM's origins are traceable to the late 19th century, when blood transfusion wasn't feasible for managing exsanguinating haemorrhage or critical anaemia. Landsteiner's discovery of the ABO blood groups firmly established blood component therapy into medical therapeutics. This article recounts the journey from a pre-blood transfusion era patient-centred approach, through the 20th century's blood product focus, and thenceforth back to the patient with the advent of PBM.
{"title":"Roads travelled: The journey to Patient Blood Management at 35 years","authors":"James P. Isbister","doi":"10.1016/j.bpa.2023.10.001","DOIUrl":"10.1016/j.bpa.2023.10.001","url":null,"abstract":"<div><div>Patient Blood Management evolved in recent years, focusing on the haematopoietic system as relevant to all disciplines of medicine. The allogeneic blood supply chain travels from donation, to fractionation, preservation, and storage, to therapeutic, established treatments, or prophylactics for a wide range of medical conditions. This supply chain ‘connects’ altruistic blood donors to patients in need, symbolising a ‘gift relationship’, emphasising the empathetic bond between donor and recipient.</div><div>In 1988, the author proposed a paradigm shift in blood transfusion and, in 2005, introduced the term Patient Blood Management (PBM). PBM's origins are traceable to the late 19th century, when blood transfusion wasn't feasible for managing exsanguinating haemorrhage or critical anaemia. Landsteiner's discovery of the ABO blood groups firmly established blood component therapy into medical therapeutics. This article recounts the journey from a pre-blood transfusion era patient-centred approach, through the 20th century's blood product focus, and thenceforth back to the patient with the advent of PBM.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 439-450"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135965479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.11.006
Nicole Relke , Grace H. Tang , Michelle Sholzberg
Peri-operative bleeding is a major cause of morbidity and mortality in patients undergoing surgery. Tranexamic acid, an antifibrinolytic agent, is effective for prevention and treatment of bleeding in a variety of different surgical populations. This review summarizes the evidence supporting the use of tranexamic acid in major surgical settings including cardiac surgery, obstetrics, orthopedic surgery, and non-cardiac surgery. We discuss potential adverse effects with use of tranexamic acid including the theoretical risk of thrombosis. Lastly, we discuss other potential benefits of tranexamic acid including prevention of infection and maintenance of blood-brain barrier integrity.
{"title":"Intra-operative tranexamic acid: A standard of care?","authors":"Nicole Relke , Grace H. Tang , Michelle Sholzberg","doi":"10.1016/j.bpa.2023.11.006","DOIUrl":"10.1016/j.bpa.2023.11.006","url":null,"abstract":"<div><div><span>Peri-operative bleeding is a major cause of morbidity and mortality in patients undergoing surgery. </span>Tranexamic acid<span>, an antifibrinolytic agent<span><span>, is effective for prevention and treatment of bleeding in a variety of different surgical populations. This review summarizes the evidence supporting the use of tranexamic acid in major surgical settings including cardiac surgery, obstetrics, orthopedic surgery, and non-cardiac surgery. We discuss potential </span>adverse effects with use of tranexamic acid including the theoretical risk of thrombosis. Lastly, we discuss other potential benefits of tranexamic acid including prevention of infection and maintenance of blood-brain barrier integrity.</span></span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 468-476"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.10.004
Arun Muthukumar , Juan Jose Guerra-Londono , Juan P. Cata
Patients with cancer who receive allogeneic red blood cell transfusions are at risk of adverse reactions of varying severity. One of these reactions is immunomodulation, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor. Leucocytes are believed to be implicated in storage lesions and immunomodulation. However, the efficacy of leucodepletion in reducing immunomodulation is controversial. The theoretical link between these three interconnected events - storage lesions, immunomodulation and cancer progression remain controversial and poorly understood. This article summarizes the available evidence on efficacy of leucodepletion, storage lesions and transfusion related immunomodulation, while rationalizing the possible association between an immunomodulation triggering transfusion ‘dose’ in cancer patients and subsequent cancer recurrence.
{"title":"Does one unit really matter? Immunological effects of transfusion after universal leucodepletion","authors":"Arun Muthukumar , Juan Jose Guerra-Londono , Juan P. Cata","doi":"10.1016/j.bpa.2023.10.004","DOIUrl":"10.1016/j.bpa.2023.10.004","url":null,"abstract":"<div><div><span><span>Patients with cancer who receive allogeneic red blood cell transfusions are at risk of </span>adverse reactions of varying severity. One of these reactions is </span>immunomodulation<span><span>, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor. Leucocytes are believed to be implicated in storage lesions and immunomodulation. However, the efficacy of leucodepletion in reducing immunomodulation is controversial. The theoretical link between these three interconnected events - storage lesions, immunomodulation and cancer progression remain controversial and poorly understood. This article summarizes the available evidence on efficacy of leucodepletion, storage lesions and transfusion related immunomodulation, while rationalizing the possible association between an immunomodulation triggering transfusion ‘dose’ in cancer patients and subsequent </span>cancer recurrence.</span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 495-502"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.11.005
Gregory MT Hare , Ahmad Alli , Helen Jiang , C David Mazer
Anemia and red blood cell transfusion are associated with adverse outcomes. Large randomized trials have demonstrated that restrictive transfusion strategies can safely reduce patient exposure to transfusion, forming a foundational pillar of patient blood management. The restrictive transfusion thresholds in these trials ranged from 7 to 8 g/dL for different populations and this variability is reflected in recent guideline recommendations for transfusion triggers. Such variability implies heterogeneity among populations with respect to the transfusion threshold for optimal outcomes. Individual variability (tolerance to anemia, risk of tissue hypoxia, risk of red blood cell transfusion) has not been addressed by population-based trials, supporting the argument for ‘physiological transfusion triggers’ indicative of inadequate organ perfusion. However, physiological triggers have only been assessed in small feasibility trials without convincing outcome data. This review summarizes data from recent transfusion trials and transfusion guidelines, and reviews potential physiological triggers which could further refine transfusion practices and minimize risks of tissue hypoxia and adverse outcomes.
{"title":"How low can you go: Restrictive transfusion strategies in major surgery and physiological triggers","authors":"Gregory MT Hare , Ahmad Alli , Helen Jiang , C David Mazer","doi":"10.1016/j.bpa.2023.11.005","DOIUrl":"10.1016/j.bpa.2023.11.005","url":null,"abstract":"<div><div>Anemia and red blood cell transfusion<span><span> are associated with adverse outcomes. Large randomized trials have demonstrated that restrictive transfusion strategies can safely reduce patient exposure to transfusion, forming a foundational pillar of patient blood management. The restrictive transfusion thresholds in these trials ranged from 7 to 8 g/dL for different populations and this variability is reflected in recent guideline recommendations for transfusion triggers. Such variability implies heterogeneity among populations with respect to the transfusion threshold for optimal outcomes. Individual variability (tolerance to anemia, risk of </span>tissue hypoxia, risk of red blood cell transfusion) has not been addressed by population-based trials, supporting the argument for ‘physiological transfusion triggers’ indicative of inadequate organ perfusion. However, physiological triggers have only been assessed in small feasibility trials without convincing outcome data. This review summarizes data from recent transfusion trials and transfusion guidelines, and reviews potential physiological triggers which could further refine transfusion practices and minimize risks of tissue hypoxia and adverse outcomes.</span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 477-485"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143234801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.11.001
Jody A. Rusch , Diederick J. van der Westhuizen , Robert S. Gill , Vernon J. Louw
Iron deficiency, a pervasive global health issue, necessitates precise and reliable diagnostic methods, especially in clinical and surgical settings. This review examines an array of established markers of iron status, encapsulating parameters such as serum iron, ferritin, transferrin, and transferrin saturation alongside novel biomarkers like soluble transferrin receptor, zinc protoporphyrin, and hepcidin. We further scrutinise the potential and limitations of routine and novel diagnostic tools and strategies in distinguishing different anaemic conditions, such as iron deficiency anaemia, iron-restricted erythropoiesis, and anaemia of inflammation. Through a critical lens, we elucidate the current paradigms and pressing questions surrounding the diagnostic criteria and clinical ramifications of iron metabolism. By weaving together the nuances and diverging perspectives within the domain of iron deficiency diagnosis and management, this review aspires to foster a clearer understanding that can steer improved patient care and shape the trajectory of future research in this vital field.
{"title":"Diagnosing iron deficiency: Controversies and novel metrics","authors":"Jody A. Rusch , Diederick J. van der Westhuizen , Robert S. Gill , Vernon J. Louw","doi":"10.1016/j.bpa.2023.11.001","DOIUrl":"10.1016/j.bpa.2023.11.001","url":null,"abstract":"<div><div>Iron deficiency, a pervasive global health issue, necessitates precise and reliable diagnostic methods, especially in clinical and surgical settings. This review examines an array of established markers of iron status, encapsulating parameters such as serum iron, ferritin, transferrin, and transferrin saturation alongside novel biomarkers like soluble transferrin receptor, zinc protoporphyrin, and hepcidin. We further scrutinise the potential and limitations of routine and novel diagnostic tools and strategies in distinguishing different anaemic conditions, such as iron deficiency anaemia, iron-restricted erythropoiesis, and anaemia of inflammation. Through a critical lens, we elucidate the current paradigms and pressing questions surrounding the diagnostic criteria and clinical ramifications of iron metabolism. By weaving together the nuances and diverging perspectives within the domain of iron deficiency diagnosis and management, this review aspires to foster a clearer understanding that can steer improved patient care and shape the trajectory of future research in this vital field.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 451-467"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.11.003
Amir Zabida , Justyna Bartoszko , Keyvan Karkouti
Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin concentrates, fibrinogen concentrates and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate. This review discusses these compounds, compares them to conventional blood products, discusses the trial data supporting their use, and reviews indications for intraoperative transfusion based on point-of-care testing and conventional laboratory results. While factor concentrates have become an increasingly popular option for treating acquired factor deficiency in surgical patients, evidence is evolving and clinical trial data in one surgical patient population may not be transferable to another. High quality clinical studies will help optimize management of coagulopathy and improve patient outcomes while decreasing any associated risks.
{"title":"Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy – Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII","authors":"Amir Zabida , Justyna Bartoszko , Keyvan Karkouti","doi":"10.1016/j.bpa.2023.11.003","DOIUrl":"10.1016/j.bpa.2023.11.003","url":null,"abstract":"<div><div>Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy<span>. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin<span> concentrates, fibrinogen concentrates<span> and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate. This review discusses these compounds, compares them to conventional blood products, discusses the trial data supporting their use, and reviews indications for intraoperative transfusion based on point-of-care testing and conventional laboratory results. While factor concentrates have become an increasingly popular option for treating acquired factor deficiency in surgical patients, evidence is evolving and clinical trial data in one surgical patient population may not be transferable to another. High quality clinical studies will help optimize management of coagulopathy and improve patient outcomes while decreasing any associated risks.</span></span></span></div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 527-536"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135716959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.11.002
Ethan H. Crispell , Jessica Trinh , Matthew A. Warner
Postoperative anaemia is common among surgical patients. While often viewed as a benign condition, postoperative anaemia is neither inevitable nor harmless, being intricately linked with adverse outcomes. In this review, we summarize the prevalence, aetiology, and outcomes of postoperative anaemia and highlight prevention and management strategies. Further, we propose a novel framework to characterize postoperative anaemia as an acute organ injury (i.e., acute blood injury, anaemic subtype), thereby drawing attention to a condition that is frequently overlooked. Additionally, we discuss areas warranting further research, including risk stratification for patients at heightened risk for the development of postoperative anaemia and associated complications and determination of appropriate treatment strategies.
{"title":"Postoperative anaemia: Hiding in plain sight","authors":"Ethan H. Crispell , Jessica Trinh , Matthew A. Warner","doi":"10.1016/j.bpa.2023.11.002","DOIUrl":"10.1016/j.bpa.2023.11.002","url":null,"abstract":"<div><div><span>Postoperative anaemia is common among surgical patients. While often viewed as a benign condition, postoperative anaemia is neither inevitable nor harmless, being intricately linked with adverse outcomes. In this review, we summarize the prevalence, aetiology, and outcomes of postoperative anaemia and highlight prevention and management strategies. Further, we propose a novel framework to characterize postoperative anaemia as an acute organ injury (i.e., acute blood injury, anaemic subtype), thereby drawing attention to a condition that is frequently overlooked. Additionally, we discuss areas warranting further research, including </span>risk stratification for patients at heightened risk for the development of postoperative anaemia and associated complications and determination of appropriate treatment strategies.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 486-494"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135615521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.1016/j.bpa.2023.11.004
Adam Irving , Zoe K. McQuilten
Patient blood management is the umbrella term for a suite of initiatives designed to optimise blood product usage, minimise transfusion needs, and ensure appropriate and evidence-based transfusion practices. In this review we summarise published economic evaluations of patient blood management to determine whether they represent good value for money. We identified 54 economic evaluations of patient blood management, the majority of which had positive cost-effectiveness conclusions. In particular, anaemia management with ferric carboxymaltose, adopting a restrictive transfusion strategy, and the administration of tranexamic acid appear likely to be highly cost effective. Intraoperative cell salvage may be cost effective if used in patients at high risk of bleeding. Overall, patient blood management programmes are likely to reduce costs and improve patient outcomes in a wide range of patient populations. No identified evaluations included an assessment of the impact of patient blood management on preserving the blood supply.
{"title":"Does patient blood management represent good value for money?","authors":"Adam Irving , Zoe K. McQuilten","doi":"10.1016/j.bpa.2023.11.004","DOIUrl":"10.1016/j.bpa.2023.11.004","url":null,"abstract":"<div><div>Patient blood management is the umbrella term for a suite of initiatives designed to optimise blood product usage, minimise transfusion needs, and ensure appropriate and evidence-based transfusion practices. In this review we summarise published economic evaluations of patient blood management to determine whether they represent good value for money. We identified 54 economic evaluations of patient blood management, the majority of which had positive cost-effectiveness conclusions. In particular, anaemia management with ferric carboxymaltose, adopting a restrictive transfusion strategy, and the administration of tranexamic acid appear likely to be highly cost effective. Intraoperative cell salvage may be cost effective if used in patients at high risk of bleeding. Overall, patient blood management programmes are likely to reduce costs and improve patient outcomes in a wide range of patient populations. No identified evaluations included an assessment of the impact of patient blood management on preserving the blood supply.</div></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 4","pages":"Pages 511-518"},"PeriodicalIF":4.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135670225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.bpa.2022.11.006
Gert-Jan Eerdekens (MD, Anesthesia Consultant) , Dieter Van Beersel (MD, PhD-Student, Anesthesia Consultant) , Steffen Rex (MD, PhD, Associate Professor, Head of the Anesthesia Department) , Marc Gewillig (MD, PhD, Professor, Pediatric Cardiologist) , An Schrijvers (MD, Anesthesia Consultant) , Layth AL tmimi (MD, PhD, Associate Professor, Anesthesia Consultant)
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists’ Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator.
Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.
{"title":"The patient with congenital heart disease in ambulatory surgery","authors":"Gert-Jan Eerdekens (MD, Anesthesia Consultant) , Dieter Van Beersel (MD, PhD-Student, Anesthesia Consultant) , Steffen Rex (MD, PhD, Associate Professor, Head of the Anesthesia Department) , Marc Gewillig (MD, PhD, Professor, Pediatric Cardiologist) , An Schrijvers (MD, Anesthesia Consultant) , Layth AL tmimi (MD, PhD, Associate Professor, Anesthesia Consultant)","doi":"10.1016/j.bpa.2022.11.006","DOIUrl":"https://doi.org/10.1016/j.bpa.2022.11.006","url":null,"abstract":"<div><p><span>The number of patients with congenital heart disease (CHD) undergoing </span>ambulatory surgery<span> is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists’ Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator.</span></p><p>Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 3","pages":"Pages 421-436"},"PeriodicalIF":4.8,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50198451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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