Current opinion in anaesthesiology
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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 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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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.