Current anaesthesia and critical care最新文献

Organ shortage is one of the most pressing issues concerning the field of transplantation. Non Heart Beating Donation (NHBD) has long been recognized as a potential tool to increase the size of the donor pool. In this study we have discussed the common issues, controversies and current trends relating to NHBD and possible solutions to establish a successful programme.

The adaptation of videotechnology for laryngoscopy appears to be an interesting and promising option in the field of airway management. The place of videolaryngoscope-assisted intubation in airway management has yet to be determined. This article will aim to describe the technique of videolaryngoscopy, discuss the videolaryngoscopes that are currently available and give a summary of the available evidence for their use.

Many patients presenting for V-R surgery are elderly with a high incidence of associated medical conditions. Thorough preoperative assessment is essential especially for those scheduled for general anaesthesia.

Patients on anticoagulants and antiplatelet drugs scheduled for V-R surgery should continue their routine medication. However, where there are specific concerns, the anaesthetist, surgeon and patient should discuss the risks and benefits of continuing their routine medication to agree an acceptable approach.

Local anaesthetic techniques are now far more commonly used than general anaesthesia for V-R surgery. Clinicians must recognize the limitations and contraindications of both approaches.

Whenever local anaesthetic techniques are used, attention to small details can make a huge difference to patient comfort. This often entails meticulous patient positioning and clear lines of communication between patient and the theatre team. Sometimes, sedative drugs are beneficial to patient care.

Careful patient monitoring is recommended during V-R surgery because of the darkened theatre environment, the age and associated medical conditions of many of these patients, and the risk of precipitating abnormal cardiac rhythms from drugs and the oculocardiac reflex.

Many patients undergoing ophthalmic surgery have significant co-morbidity. Many take anticoagulant or antiplatelet drugs. Stopping these drugs in patients with heart or vascular disease may result in death from a thromboembolic episode. The risk of this must be balanced against the risk of bleeding. In general, the risks of stopping these drugs outweigh the risks of ophthalmic surgery, which is in most cases confined to the eye. The majority of eye surgery is now performed under local anaesthesia (LA). There is no strong evidence currently to favour blunt cannula techniques such as sub-Tenon’s block over traditional sharp needle peribulbar block in patients on anticoagulant or antiplatelet therapy. Most studies are too small to detect a significant difference when comparing patients on anticoagulant or antiplatelet medication with those that are not, but the incidence of significant sight threatening haemorrhagic complications appears to be very low for cataract surgery, of the order of 3 per 10,000 operations.

There is some concern that drug and food interactions may affect anticoagulation with warfarin and it is recommended that the International Normalized Ratio (INR) be measured as close to the time of operation as possible.

Conclusions reached for ambulatory cataract surgery may not apply to more invasive and complex operations.

Needle-based anaesthetic techniques were described in the nineteenth century and since have undergone many changes. Although the use of needle-based blocks has declined due to their complications and the emergence of safer alternative methods of local anaesthesia, they remain very popular in many countries. This review article describes the evidence based use of needle ophthalmic blocks for modern ophthalmic surgery.

Controversies exist regarding optimal anesthetic management of patients receiving surgery for ocular trauma. Ocular injuries are commonly encountered in clinical practice as an estimated 750,000 patients are hospitalized with eye injuries annually throughout the world. Many, particularly those with open globe injuries, require surgery, often under emergency conditions that make the patient’s anesthetic management challenging. This paper reviews epidemiological data illustrating the prevalence and incidence of serious eye injuries and then presents a case study detailing the anesthetic management of a severely traumatized patient to illustrate a discussion of current options and recommendations for the management of such cases.