Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2010
ReviewNear infrared spectroscopy in children at high risk of low perfusion.
Tissue oximetry has been suggested as a noninvasive tool to continuously monitor and detect states of low body perfusion. This review summarizes recent developments and available data on the use of near infrared spectroscopy (NIRS) in children at risk for low perfusion. ⋯ Despite shortcomings in the ability of NIRS technology to accurately reflect validated and directly measured parameters of systemic oxygen delivery and blood flow, NIRS can certainly assist in the detection of low-flow states (low cardiac output). Large, randomized, prospective studies with well defined outcome parameters are still missing and warranted in order to clearly define the role of NIRS in children at risk for low perfusion.
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Patients often receive preoperative therapies that interfere with hemostasis, and can present for surgery with underlying hemostatic disorders because of pre-existing preoperative anticoagulation or antiplatelet therapy. Perioperative bleeding can occur following surgery due to multiple causes; however, the addition of pharmacologic agents creates an acquired defect that complicates the surgical injury and may result in increased blood loss. An understanding of the potential impact of anticoagulation therapies on hemostasis is critical in managing these patients. Further, newer agents are evolving in clinical practice that clinicians should be aware of. ⋯ There are multiple pharmacologic therapies that surgical patients may be exposed to preoperatively, although there are currently few available methods to antagonize their effects. Often therapeutic prohemostatic pharmacologic approaches are used to treat or prevent bleeding, in addition to transfusional therapies.
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There is an emerging epidemic of obesity worldwide resulting in a greater number of obese patients presenting for surgery. The combined problems of metabolic disease and mechanical impairment from excess tissues present a variety of problems for the anesthesiologist. ⋯ Current studies have focused on the immediate impact of obesity on anesthesia and postoperative care. Future research will focus primarily on perioperative metabolic optimization.
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Labor is among the most painful experiences that humans encounter. Neuraxial analgesia is the most effective means of treating this pain. In this review, we discussed the effect of neuraxial analgesia on the progress of labor when compared with parenteral opioids. We then compared initiation of analgesia with a combined spinal-epidural technique (CSE) to conventional epidural analgesia. Finally we discussed the impact of neuraxial analgesia, given early in labor, compared with later administration. ⋯ Neuraxial analgesia does not interfere with the progress or outcome of labor. There is no need to withhold neuraxial analgesia until the active stage of labor.
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Curr Opin Anaesthesiol · Jun 2010
ReviewWhat are the current indications for noninvasive ventilation in children?
The aims of this paper are to examine the physiological rationale for noninvasive respiratory support (NRS) in children older than 1 month with acute respiratory failure, to review clinical available data and to give some practical recommendations for the safe application of NRS. ⋯ Preliminary clinical data show that NRS is safe and effective in children with acute respiratory failure.