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The Acute Care Anesthesiologist as Resuscitationist

7/21/2017

 
The Acute Care Anesthesiologist as Resuscitationist
Conti, Bianca MD; Greco, Karla M. MD, MHS; McCunn, Maureen MD, MIPP, FCCM
International Anesthesiology Clinics:  Summer 2017 - Volume 55 - Issue 3 - p 109–116
doi: 10.1097/AIA.0000000000000148


Abstract:
Resuscitation from critical illness or traumatic injury is no longer defined by massive crystalloid infusions, blood product transfusions without defined endpoints, or initiation of vasoactive medications at the physician’s discretion. Clearly defined, data-driven guidelines now exist that target specific goal-directed therapies in trauma, sepsis, and emergency general surgery, and incorporate both therapeutic and bedside diagnostic adjuncts. Ongoing research and controversy regarding resuscitation strategies in patients after trauma, for emergency surgery, or with sepsis will undoubtedly change current management paradigms. There is a need to maintain up-to-date knowledge and clinical excellence in the science of resuscitation that may suggest the need for specialization and expertise in the field of anesthesiology.
Anesthesiology has become more subspecialized, with recognized Accreditation Council for Graduate Medical Education (ACGME) fellowships offered in pediatrics, cardiac, critical care, pain management, and, most recently, obstetrics and regional anesthesia. There is currently a proposal to highlight the need for an additional American Board of Anesthesiology (ABA)/ACGME-approved fellowship—through the critical care track—targeted at trauma, acute care, and emergency care anesthesia practice: the acute care anesthesiologist. The question of whether this training should be unique to anesthesiologists, or should be combined with training in emergency medicine, has also been raised.Regardless of the structured curriculum that eventually develops, the management of resuscitation is rapidly maturing.
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Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology

7/12/2017

 
Foto
European Journal of Anaesthesiology 2017;34(6):332–395.
The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.
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