Current opinion in anaesthesiology
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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.
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This review examines the literature on the ability of an epidural test dose to detect intravascular or intrathecal epidural catheter misplacement in the obstetric patient. ⋯ Gentle aspiration followed by an appropriate test dose, in epidural anesthesia for cesarean section, and careful observation of the patients in epidural labor analgesia increase the likelihood that an incorrectly placed catheter will be detected and that a harmful reaction to local anesthetics will be avoided.
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Curr Opin Anaesthesiol · Jun 2009
ReviewAnaesthesia and Parkinson's disease: how to manage with new therapies?
Parkinson's disease is the second most prevalent neurodegenerative disease and presents a particular anaesthetic challenge. The clinical features are described in detail, and recent advances in medical management and neurosurgical treatment options are highlighted. ⋯ DBS is an attractive option for severely disabled patients with Parkinson's disease who pose a particular anaesthetic challenge.
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Curr Opin Anaesthesiol · Jun 2009
ReviewComparison of different techniques of laryngeal mask placement in children.
The insertion of laryngeal mask airway is not always easy in children, and many techniques are described to improve success rate of placement. It is very important to determine the optimal insertion technique as unsuccessful prolonged insertion and multiple attempts are associated with adverse respiratory events and trauma in children. This article will review different techniques studied recently for the placement of classical laryngeal mask airway in children as well as recent findings of cuff pressure and depth of anesthesia for laryngeal mask airway placement. Laryngeal mask airway in children has undergone many modifications such as ProSeal laryngeal mask airway to improve its functioning. This article will also review different insertion techniques for ProSeal laryngeal mask airway. ⋯ Rotational technique may be considered as the first technique of choice for classical laryngeal mask airway insertion in children. The routine use of cuff pressure monitoring is mandatory during the use of laryngeal mask airway in children. Modification of laryngeal mask airway in children, that is ProSeal laryngeal mask airway, is promising and improves the success rate of insertion.
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The most recent findings on preeclampsia with a focus on maternal mortality, haemodynamic changes, clotting disorders and anaesthesia are reviewed. ⋯ Cerebral haemorrhage is the major cause of maternal mortality in preeclampsia and any increases in maternal blood pressure above 160 mmHg or at induction of general anaesthesia should be treated. Traditional rapid sequence induction is, therefore, best avoided; neuraxial anaesthesia is the technique of choice.