Recent advances in perioperative medicine: highlights from the literature for the cardiothoracic and vascular anesthesiologist.
There have been major advances in perioperative cardiothoracic and vascular medicine. Because of promising data, steroids, statins, and endothelin antagonists are being clinically tested in randomized trials with adult cardiac surgical patients. In vascular surgical patients, recent meta-analysis has revealed that interventions such as beta-blockade or endovascular stenting for peripheral vascular lesions may not improve outcome overall. Furthermore, a landmark trial has shown that anesthetic technique does not affect outcome after carotid endarterectomy. The surgical Apgar score may become part of routine clinical care of the vascular surgical patient because it predicts outcome and can be calculated at the bedside. Recent studies confirm that the serious perioperative risks of hyperglycemia also apply to nondiabetic and pediatric cardiac surgical patients. This has been highlighted in the new guidelines from the Society of Thoracic Surgeons. Perioperative myocardial protection is possible with ischemic preconditioning and omega-3 fatty acids. Pneumonia after lung resection may be reduced significantly by broadening antibiotic prophylaxis. Transfusion-related acute lung injury has immediate and delayed presentations that highlight the dangers of blood transfusion. Perioperative renal dysfunction after adult cardiac surgery is significantly reduced by the infusion of sodium bicarbonate. Although promising, further trials are required. Taken together, these recent advances will have significant influence on the future practice of cardiovascular and thoracic anesthesia as the ongoing search for perioperative outcome improvement achieves results.
Department of Anesthesiology and Critical Care, Cardiothoracic Section, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com
John G T
JG
Augoustides
Prakash
P
Patel
D000776:Anesthesiology / Q000379:methods / Q000639:trends*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D006801:Humans; D019990:Perioperative Care / Q000379:methods / Q000639:trends*; D010820:Physicians / Q000639:trends*; D011183:Postoperative Complications / Q000517:prevention & control