Current opinion in anaesthesiology
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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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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.
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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.
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Curr Opin Anaesthesiol · Jun 2009
ReviewSpontaneous respiration during intravenous anesthesia in children.
Maintaining spontaneous respiration during intravenous anesthesia for investigative and surgical procedures may avoid the need for airway instrumentation and reduce the risk of desaturation. In addition, when performing airway endoscopic procedures in children, maintaining spontaneous respiration while using intravenous anesthesia can reduce the need for endotracheal intubation. This facilitates improved access to the smaller airway, allows assessment of the dynamic function of the airway, and reduces exposure of personnel to inhaled anesthetic agents. ⋯ Spontaneous respiration can be maintained when anesthetizing children using intravenous anesthesia.