Current opinion in anaesthesiology
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The literature on the appropriate dose of local anaesthetic and combinations with opioids for spinal anaesthesia for caesarean section in patients without comorbid conditions is reviewed. The controversial issue of spinal anaesthesia in severe preeclampsia is also addressed. ⋯ Low-dose spinal anaesthesia has been advocated in the interests of improving cardiovascular stability. However, current sophistication of knowledge concerning spinal anaesthetic technique makes cardiovascular instability easy to prevent. Therefore this review emphasizes the importance of adequate surgical anaesthesia during caesarean section, and makes suggestions as to the optimal pharmacological agents for intraoperative anaesthesia and postoperative analgesia. Spinal anaesthesia is safe in severe preeclampsia, provided there are no contraindications to regional anaesthesia.
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Curr Opin Anaesthesiol · Aug 2004
Morbidity and mortality related to anaesthesia outside the operating room.
The purpose of this review is to provide information related to morbidity and mortality associated with anaesthesia outside the operating room. ⋯ There is certainly a need for studies concerning morbidity and mortality at remote location anaesthesia. Special care for the prevention of hypothermia should be given to those patients undergoing long-lasting diagnostic procedures, e.g. magnetic resonance imaging scans or cardiological investigations.
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This review focuses on the technological principles, safety considerations, monitors and equipment, patient issues, and a general overview of the anesthetic management of both conventional and intraoperative magnetic resonance imaging based on the most recent literature. ⋯ The magnetic resonance imaging suite is a challenging environment for the anesthesiologist, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner, and patient-related factors. Understanding the implications of the magnetic resonance imaging environment will facilitate ensuring the safety of the patient and personnel.
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Curr Opin Anaesthesiol · Aug 2004
Fetal effects of maternal supplementary oxygen during Caesarean section.
This review summarises the current issues, knowledge and research on the effects of maternal supplementary oxygen therapy on the fetus during Caesarean section. This is a controversial subject since supplementary oxygen has the potential to confer both benefits and also harm to the fetus, depending on the circumstances. ⋯ For elective Caesarean section, current evidence suggests that supplementary oxygen is unnecessary. For emergency Caesarean section, further data are required before a conclusion can be made for its beneficial and adverse effects. Improvement of fetal oxygenation should be the primary objective, and this is achievable in the short term by using a very high FiO2. Although there is also a possibility of an enhanced reperfusion injury, particularly in the preterm and non-labouring patients, further data are necessary before a conclusion can be made.
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Since the early 1990s, advances in endoscopic equipment and the commercial availability of micro-catheters, mini-balloons, tiny laser fibers and other ingenious tools have set the trend toward the development of minimally invasive fetoscopic surgical techniques for the treatment of some congenital malformations that progress in severity over the course of gestation and may destroy entire organ systems of the unborn. The purpose of this review is to provide a state-of-the-art overview of these new procedures for the anesthesiologist. ⋯ An increasing spectrum of congenital malformations can be treated by fetoscopic surgery. Compared to open fetal surgery, fetoscopic surgery results in significantly less maternal trauma. Like the open procedures, the efficacy of the fetoscopic procedures to improve fetal outcome over postnatal treatment strategies will have to be assessed in further studies under close supervision of committees for human research.