Current opinion in anaesthesiology
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Multiple sclerosis remains prevalent among young women in the United States of America. It is a disease of the central nervous system that possesses many anesthetic implications. Anesthesia providers need to understand this disorder and its multiple anesthetic ramifications. ⋯ In summary, our aim is to provide an updated view of multiple sclerosis from the perspective of perioperative care, emphasizing interactions between the disease, surgery and anesthesia.
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Curr Opin Anaesthesiol · Jun 2002
Upper airway infection and pediatric anesthesia: how is the evidence based?
Anesthesia for the child with an upper respiratory infection remains one of the most common, yet contentious, issues facing the pediatric anesthesiologist. A general lack of evidence-based research has led to disparities in the manner in which children with upper respiratory infections have been traditionally managed. More recent research, however, suggests that children with uncomplicated infections can be managed safely, given that most complications can be anticipated, recognized, and treated. This review summarizes the evolving literature regarding cancellation of surgery for the child with an upper respiratory infection, perioperative outcomes, and anesthetic management.
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This review aims to summarize results of recently published studies concerning clonidine application in paediatric anaesthesia, to analyse trends in these studies, and to discuss perspectives of the perioperative use of clonidine for children. ⋯ Clonidine may be less favored than midazolam as premedication for children because of inferior clonidine-induced sedation. Additional comparative studies are required, however, to confirm this finding. On the other hand, clonidine-induced analgesia may well be useful and find wide application in paediatric anaesthesia. Prospective multicentre trials using a larger number of patients will be needed to verify the usefulness of caudal clonidine for postoperative pain relief. Prophylactic use of clonidine against sevoflurane-induced agitation may represent a new and promising application. Assessment of the efficacy of clonidine in potentiating regional anaesthesia/analgesia by local anaesthetics in children also needs more investigation. Moreover, it may be worthwhile to try new successful applications demonstrated in adults for paediatric anaesthesia.
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Curr Opin Anaesthesiol · Jun 2002
Aspiration in pediatric anesthesia: is there a higher incidence compared with adults?
Recent data in both adults and children have suggested that the incidence and severity of the pulmonary aspiration of gastric contents has declined. Previous studies have indicated that aspiration is more common in children than in adults. This review will examine the available data to compare the incidence and severity of aspiration in adults and children. ⋯ Based on the available data, aspiration appears to be slightly more common in children than in adults. The difference, however, is less than that previously reported. Morbidity associated with aspiration is rare in all age groups. This is especially true for children.
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In neonates, epidural catheters inserted at the sacral hiatus can easily be advanced to a lumbar or thoracic level. These 'caudal catheters' are popular because they allow the neonate to benefit from epidural analgesia without the concerns of spinal cord injury potentially associated with primary thoracic placement in an asleep neonate. This review looks at use and benefits, and risks and complications of caudal epidural catheters in neonates. ⋯ Epidural anesthesia and analgesia for neonates should be performed and managed by pediatric anesthesiologists. Potential risks and complications must be appreciated and all steps to maximize safety of the technique must be taken. In particular, close postoperative observation and pain service management are indispensable. Future research should investigate the risks of caudal and segmentally placed catheters in neonates, study the role of epidural analgesia in outcome improvement for neonates, and guide us to safer use of local anesthetics suitable for neonates with their pharmacologic immaturity.