Current opinion in anaesthesiology
-
Pediatric sedation continues to evolve. It is an area of practice that involves a variety of pediatric subspecialties, the practitioners of many of which are not fully aware of what is being done by others involved in this care. The purpose of this review is to consider the current status of pediatric sedation in general and to discuss the most recent literature concerning this practice. Specifically we will discuss the use of new medications for pediatric sedation, issues concerning fasting status, issues surrounding the effectiveness of sedation, and discharge criteria after sedation. ⋯ Anesthesiologists and those outside of anesthesiology are employing new potent sedative hypnotic agents to accomplish effective pediatric sedation. At the same time, the consensus-generated sedation guidelines--particularly with respect to fasting guidelines--are being questioned. All of this is occurring in the face of mounting evidence that sedation depth needs to be adequate to provide optimal operating conditions and patient satisfaction. Regardless of sedation method used, recovery criteria need to be carefully considered in order to optimize patient safety.
-
The next couple of decades will be characterized by an increase in life expectancy, leading to an older population. As the incidence of Alzheimer's dementia and vascular dementia is rising with age, the future anaesthesiologist will be increasingly confronted with perioperative care of patients with impaired cognitive function. This paper tries to highlight some topics specifically related to demented patients. ⋯ Anaesthesia in the demented patient may be complicated by a number of potential problems, including the comorbid pathology, the concomitant anticholinesterase activity, the need for normoventilation, monitoring of anaesthesia depth and the evaluation of postoperative pain. Anaesthesia in variant Creutzfeldt-Jakob disease is aimed at preventing the spread of the causing prion. There is a broad consensus that early return to the preoperative level of cognition is to be pursued, with the help of short-acting drugs and loco-regional anaesthesia.
-
This review will focus on recently published data concerning side effects and complications of paediatric regional anaesthesia, putting into perspective the currently used techniques. ⋯ Paediatric regional anaesthesia is now widely used for postoperative pain relief in children. However, a careful risk-benefit analysis is always mandatory before such medical interventions are undertaken.
-
Anesthetic management guided by bispectral index monitoring has been demonstrated to facilitate earlier recovery in adults. Recent preliminary data also suggest that titration of drugs to achieve a specific bispectral index value may reduce the incidence of intraoperative awareness in high-risk adults. It is unclear, however, if this technology will benefit children as it is based on an algorithm developed from adults. This article reviews the literature on the use of the bispectral index monitor in children. ⋯ Bispectral index monitoring may be used to guide anesthetic administration in older children, but its use as a tool for guiding sedation in the younger pediatric patient needs further investigation. It may be necessary to develop a different bispectral index algorithm for children in the younger age groups.
-
Paediatric airway problems are among the most challenging clinicians will face throughout their career. Clinicians unaccustomed to dealing with children tend to approach paediatric airway problems with a disproportionate amount of fear that is often engendered by inexperience, and this fear can interfere with performance. Understanding the differences between the infant upper airway and the airway in older children is important to properly manage the airway. ⋯ Planning, preparation, and teamwork are essential, and must include an awareness of problems that might occur in the recovery period. Special clinical situations such as management of the child with impending airway obstruction are discussed.