Current opinion in anaesthesiology
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Diabetes mellitus has diverse effects on all organ systems of the body. Insulin physiology and metabolic control are far more complex than previously thought. Research continues to reveal more information about the central role of insulin in metabolism. The treatment of hypertension and nephropathy as well as hyperglycemia in patients with diabetes has emerged as being critical for prevention of long-term diabetic complications. The issue of primary importance to the anesthesiologist is whether strict glycemic and hemodynamic control during the perioperative period affect outcome. ⋯ Tight long-term control of glucose and blood pressure improve outcome in patients with diabetes. The same philosophy of management is being applied to the perioperative period. Routine measurement of intraoperative blood glucose levels and appropriate insulin administration are now standard practice, but the ideal regimen for insulin administration remains to be determined.
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During the last 2 years, some interesting new devices have been made available to improve airway management in children and infants, and several studies have advanced our understanding concerning risks and benefits of the current practice in the field. Certain risk factors for airway related problems during anaesthesia in children having a cold have been identified, and new aspects of the controversy concerning the use of cuffed endotracheal tubes in children presented. Novel video-assisted systems have been introduced for the management of the difficult airway in paediatric patients, and new applications for well known devices have been suggested, such as the laryngeal mask airway serving as guidance for fibreoptic intubation. ⋯ A. Group, USA). Furthermore, the following review presents new data about the use of the cuffed oropharyngeal airway, the laryngeal tube, and the Arndt bronchus blocker in paediatric patients.