Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2007
ReviewThe pediatric cardiac patient presenting for noncardiac surgery.
To summarize results of recent papers and discuss current trends concerning anesthesia in children with congenital heart disease presenting for noncardiac surgery. ⋯ Careful preoperative evaluation, experienced anesthesiologists, suitable anesthetic agents and techniques, and the liberal use of invasive monitoring are integral parts of safe and effective anesthetic care in children with congenital heart disease. Future studies have to show whether laparoscopic surgery may be beneficial in this special subgroup of patients.
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Regional analgesia for labor pain and general anesthesia for cesarean section in the morbidly obese parturient is associated with increased maternal and perinatal complications. The purpose of this review is to describe the anesthetic management of the morbidly obese parturient. ⋯ Early preoperative assessment, epidural insertion, and replacement for failed regional anesthesia/analgesia along with preparation for general anesthesia and difficult airway intubation is advocated to decrease potential complications in the morbidly obese parturient.
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Anesthesia care for patients undergoing ambulatory gynecologic surgery has improved incrementally over the past few years. Emphasis has evolved beyond the safe provision of care, because this has largely been achieved. Comfort, speed, and efficiency have taken on new importance. ⋯ Local anesthetic use in gynecologic laparoscopy appears to improve postoperative pain control modestly, especially when given into the peritoneal cavity. Supralaryngeal airways, such as ProSeal LMA, appear to provide effective ventilation in laparoscopy, although their ability to protect against aspiration is unclear. The speed and comfort of emergence, recovery, and discharge may be improved by consciousness monitoring during general anesthesia and by drugs intended to modulate hemodynamics.
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Curr Opin Anaesthesiol · Jun 2007
ReviewPerioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery.
Cardiovascular disease is the leading cause of death after anesthesia and surgery. The preoperative identification of patients with underlying coronary artery disease is important to initiate appropriate treatment strategies in order to reduce the risk of perioperative complications. The current review will discuss new insights in the field of perioperative medicine that can be applied to clinical practice or stimulate further investigation. ⋯ New perceptions in perioperative medical management and novel developments in surgical and anesthesiology techniques continue to improve the cardiovascular outcome of patents undergoing major noncardiac surgery.
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Curr Opin Anaesthesiol · Jun 2007
ReviewThe role of the anaesthetist in the management of the pre-eclamptic patient.
Recent literature on the anaesthetist's role in the management of the patient with severe pre-eclampsia is reviewed, with particular emphasis on the role of regional anaesthesia. ⋯ The value of regional anaesthesia cannot be over-emphasized. Recent research into spinal anaesthesia for caesarean section suggests a lower susceptibility to hypotension and probably less impairment of cardiac output than in healthy parturients. Noninvasive cardiac output measurement may also have advantages in critical care management.