Current opinion in anaesthesiology
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Obese, morbidly obese and ultra-obese patients have multiple surgical procedures. Although they can have an acute abdomen, obstetric procedures, trauma-related procedures and many others, morbidly obese patients are most consistently cared for in the bariatric surgery operating room. The lessons from that group of patients can, could and, usually, should be applied in all patients who are morbidly obese and present for anesthetic care. ⋯ The number of patients with obesity and morbid obesity continues to increase. Following certain guidelines will ease the management and improve outcomes of the morbidly obese patient presenting for any surgery.
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Human immunodeficiency virus (HIV) infection is one of the major global health problems. Because the advances in treatment of HIV infection increase the patient's survival, anaesthesiologists may care for these patients during their practice. This article highlights HIV infection and anaesthetic implications. ⋯ Anaesthesia in HIV-infected patients should be individualized and depend on the status of the patient.
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Curr Opin Anaesthesiol · Jun 2009
ReviewCan we predict persistent postoperative pain by testing preoperative experimental pain?
Although it is recognized that medical and surgical procedures may lead to persistent postoperative pain, predicting which patients are at risk for developing chronic pain presents an ongoing challenge. Clinical observations indicate that similar invasive procedures associated with consequent peripheral tissue damage can cause a wide range of pain experience. This broad variability is likely a consequence of the diversity in the central pain processing of the peripherally generated noxious stimulation. Therefore, advanced psychophysical measures that dynamically represent central pain modulation mechanisms may be used to determine an individual's susceptibility to developing persistent postoperative pain. This review highlights how, and to what extent, preoperative experimental pain testing can be utilized in predicting persistent postoperative pain. ⋯ The preoperative identification of individuals who have enhanced pain sensitivity and are at risk for developing persistent postoperative pain is important to providing them with better treatment that is specifically tailored to their altered pain modulation, as represented psychophysically.
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The regimen of thiopental, succinylcholine (SCh) and unsupplemented nitrous oxide/oxygen for Caesarean section was first introduced 50 years ago. This review examines which elements have endured, what has changed, and how practice might alter in the very near future. ⋯ It is now feasible that SCh might be replaced with a high-dose rocuronium-sugammadex combination.
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Curr Opin Anaesthesiol · Jun 2009
ReviewScreening for obstructive sleep apnea before surgery: why is it important?
The purpose of this article is to review the screening tools available in the preoperative clinic for patients at risk of obstructive sleep apnea. ⋯ The STOP questionnaire is short and can be easily incorporated into routine screening of general or surgical patients.