Current anaesthesia and critical care最新文献

Donor scarcity and the increased need for organ transplantation has prompted the development of an alternative source of donors to the more conventional brain dead donor. Non Heart Beating Donors (NHBD) or Donors after Cardiac Death (DCD) produce organs that have experienced warm ischaemia, which compromises their early function. Extracorporeal membrane oxygenation offers the possibility of minimizing this inevitable damage and extending the range of organs that can be harvested.

Postoperative pulmonary dysfunction (PPD) is a frequent complication after cardiac surgery. Its pathogenesis is related to pulmonary inflammation, but this appears to be secondary to multiple etiological factors, including the surgical procedure itself, extra corporeal circulation (ECC), ischemia-reperfusion injury, and mechanical ventilation (MV). On the other hand, the presence of atelectasis remains one of the principal causes of PPD. The open lung approach (OLA) is a protective ventilation strategy, typically initiated after orotracheal intubation and maintained until extubation of the patient. Compared to a conventional ventilation strategy, OLA improves gas exchange parameters, induces a minor elevation of inflammatory mediators, and retains more residual functional capacity. Finally, recent studies have shown that the addition of low frequency ventilation during ECC can decrease the incidence of PPD after cardiac surgery.

The mechanical ventilation of neonates and children in operating theatres has always posed a challenge for anaesthesiologists. Firstly, the extreme physiological features of neonatal lungs make them very difficult to ventilate with an anaesthesia ventilator. Gattinoni’s “baby lung” concept to describe ARDS lungs in adults comes from the physiological features of neonatal lungs (low dynamic compliance, low pulmonary time constant, low FRC, high closing volume, proneness to atelectasis, high inspiratory airway resistance). Secondly, the performance and technology (peak flow, insufflation power, trigger sensitivity, ventilation modes, etc.) of anaesthesia ventilators is still less advanced than those of critical care ventilators. It is possible to ventilate a normal healthy adult lung with an anaesthesia ventilator, but even today, using circle circuits, ventilating a premature baby, newborn or child in the operating theatre can be a real challenge. Over the last 5 years, great changes have been made to anaesthesia workstations, which now boast better mechanical ventilation performance for children as well as new ventilation modes. However, there is a lack of background knowledge regarding mechanical ventilation in operating theatres, and this limits the advantages that can be derived from this new technology, and thus any potential safety improvements in paediatric surgery.

Rates of obesity are rising throughout the world. Obese patients have a number of co-morbidities and associated diseases which can impact the safe transportation of these patients. This overview of the retrieval of bariatric or obese patients will explain some of the physiological and different co-morbidities found in these patients, as well as some more practical advice when faced with transporting these patients.

Succinylcholine is a commonly used depolarizing muscle relaxant in general endotracheal anesthesia. The degradation of succinylcholine is accomplished by the human serum based enzyme pseudocholinesterase. Availability of pseudocholinesterase within the human being can be deficient as a result of an inherited or acquired cause. This case report will describe a female patient who was diagnosed with an acquired pseudocholinesterase deficiency.

This article discusses the background, logistics and safety of ECMO retrieval in New South Wales, Australia. We look at the experiences of a well established, high volume medical retrieval service and the challenges presented during the recent H1N1 swine flu pandemic. In outlining the referral and retrieval process utilised in NSW we hope that other retrieval services can gain from our experience.

Mechanical ventilation is a fundamental tool in the clinical daily management of anesthetic procedures and it constitutes a cornerstone in the final evolution of the critical patients. Historically, Volume-controlled ventilation (VCV) has been the universal ventilatory mode used by the anesthesiologists in operating theatre. Nevertheless, since Pressure-controlled ventilation (PCV) was proposed as an alternative to VCV in ICU patients with ALI/ARDS, there has been renewed interest in ventilatory pressure modes in anesthesia. At present the anesthesia workstations usually have available some different modes such as PCV or pressure support ventilation (PSV). The purpose of this review is to evaluate whether ventilatory pressure modes, such as the PCV offer some benefit over the classic VCV, during anesthesia for different types of patients and surgery.