Perioperative protective effects of statins

Although statins decrease cholesterol synthesis, they also possess ‘pleiotropic’ effects, such as enhancing the function of vascular endothelium and the stability of atherosclerotic plaques. Furthermore, they attenuate oxidative stress, inflammation, and the prothrombotic response. These diverse biological actions may explain their perioperative protective effects, especially in patients undergoing cardiac and major vascular procedures. Beyond reductions in perioperative mortality and cardiorenal complications, recent evidence also suggests outcome benefits from statin exposure in sepsis, airway hyperreactivity, and venous thromboembolism. It is likely that these agents will be increasingly prescribed perioperatively as high-quality evidence from well-designed randomized trials becomes available in the near future

Elective Total Knee Replacement in a Patient With a Left Ventricular Assist Device-Navigating the Challenges With Spinal Anesthesia.

Elective joint surgery in a patient with a left ventricular assist device (LVAD) may become increasingly common as these devices become entrenched in the management of patients with heart failure. Furthermore, regional techniques may be reasonable anesthetic options in this challenging population. This case conference discusses a spinal anesthetic for an elderly female with an LVAD who presented for an elective left total knee arthroplasty. The expert case commentaries that follow the case discussion further explore the anesthetic issues in light of the existing literature

International evidence-based recommendations on ultrasound-guided vascular access

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