Current opinion in anaesthesiology
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The present article will review the current technology and available literature regarding regional anesthesia in infants and children undergoing head and neck surgery. ⋯ The trigeminal nerve, along with the cervical nerve roots, supplies most of the sensory supply to the head and neck. The knowledge and application of the anatomical distribution of this area can increase the utilization of these blocks for a variety of different settings. The increased use of these blocks can reduce the need for additional postoperative analgesic that could in turn lead to fast-tracking of these patients and decrease the incidence of nausea and vomiting in the postoperative period.
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Curr Opin Anaesthesiol · Jun 2008
ReviewNeurological complications following central neuraxial blockades in obstetrics.
The last few decades have seen an increased use of central neuraxial blockades in obstetric patients. Central blockades provide excellent labour analgesia and safe anaesthesia for caesarean section associated with low incidence of severe complications. Therefore, an increasing number of blockades are also performed in women affected by significant disease. The risks and benefits of central blockades, however, might differ in these patients. This review addresses the risks of neurological complications following central neuraxial blockades in healthy parturients as well as in women affected by significant haemostatic and neurological disease. ⋯ Estimation of the incidence of neurological complications following central neuraxial blockades to women affected by significant disease on the basis of case reports and small series of patients is impossible. Prospective registration of high-risk patients may increase our knowledge. Application of central neuraxial blockade must follow individual evaluation.
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Curr Opin Anaesthesiol · Jun 2008
ReviewMaintaining labour epidural analgesia: what is the best option?
The intensity of labour pain is influenced by a multitude of factors. In this article, we discuss recent advances in the administration of labour epidural analgesia which have been targeted at creating a more satisfactory birthing experience for the parturient while safeguarding maternal and fetal well being. ⋯ Recent advances in medical technology have equipped us with many novel drug delivery modalities, which will enable us to customize a suitable analgesic regimen for each parturient.
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Curr Opin Anaesthesiol · Jun 2008
ReviewInfection associated with central venous or epidural catheters: how to reduce it?
Central venous catheters are a leading source of nosocomial bloodstream infection with an estimated 10% mortality. Infection associated with epidural catheterization is an uncommon but devastating complication. Diagnosis of spinal epidural abscess requires a high index of suspicion and imaging techniques such as MRI. Early diagnosis and treatment will minimize permanent damage, but primary prevention should be the aim, which depends on proper patient evaluation and use of full aseptic precautions. ⋯ Healthcare worker education and training are essential to create standardization of aseptic care. Continuous surveillance is necessary for identifying lapses in infection-control practices.
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The control of pain after scoliosis surgery is a real challenge for the anesthesiologist. The first reason is that major spine surgery for correction of scoliosis deformation causes severe postoperative pain, and second that patients undergoing these operations are most often children or adolescents who are known to suffer from increased pain sensation compared with adults. ⋯ Significant improvements have been made in the control of postoperative pain after correction of scoliosis deformation in recent years. The introduction of epidural analgesia has cleared the way for better analgesic techniques in this surgical context. Properly performed and assessed, the addition of epidural analgesia after scoliosis surgery is a safe and effective form of analgesia and the benefits far outweigh the risks.