Current opinion in anaesthesiology
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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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Many patients who smoke cigarettes require anesthesia and surgery. Their smoking can have profound consequences for perioperative management. Efforts to help them quit will be rewarded by both improved immediate postoperative outcomes and the long-term health benefits after surgery. This review will introduce basic concepts important to perioperative tobacco control and cover recent advances in the field. ⋯ The fact that the perioperative period represents an excellent opportunity to help surgical patients quit smoking is becoming increasingly apparent. Although these efforts, and the evidence base to support them, are still at an early stage of development, seizing this opportunity will benefit both the short and long-term health of our patients who smoke.
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Curr Opin Anaesthesiol · Jun 2007
ReviewPremedication of the pediatric patient - anesthesia for the uncooperative child.
Inadequate handling of an uncooperative child preoperatively results in postoperative behavior problems. Premedication enables a calm induction and helps to decrease postoperative problems. Several premedicants will be covered in this review. ⋯ The benefits and disadvantages of new and older drugs should be weighed against each other, and decisions should be made according to the requirements of surgery, ward conditions and the severity of psychologic, developmental or mental disease. Further studies for the evaluation of the anxiolytic, sedative and antipsychotic drugs are still required.
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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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Although there have been few recent publications about obstetric deaths due to anaesthesia, it is timely to review their occurrence and put them into context. Health services are under constant review and a recent Department of Health publication highlights the need for safer care. Changes, including those related to training and permitted hours of work, may impact on safety. Without knowing where we are now, we cannot know whether these changes are an improvement or not. ⋯ Medical intervention undoubtedly saves many lives. Concerns about a possible increase in anaesthetic maternal mortality must be kept in perspective with the overall benefits. The growing complexity of problems such as maternal disease, obesity, and the increasing age of motherhood, nevertheless, increases the challenges presented. Multidisciplinary working is all-important.