Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2010
ReviewAnesthesia in prehospital emergencies and in the emergency department.
Recently, notable progress has been made in the field of anesthesia drugs and airway management. ⋯ Preoxygenation should be performed with high-flow oxygen delivered through a tight-fitting face mask with a reservoir. Ketamine may be the induction agent of choice in hemodynamically unstable patients. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. Experienced healthcare providers may consider prehospital anesthesia induction. Moderately experienced healthcare providers should optimize oxygenation, hasten hospital transfer and only try to intubate a patient whose life is threatened. When intubation fails twice, ventilation should be performed with an alternative supraglottic airway or a bag-valve-mask device. Lesser experienced healthcare providers should completely refrain from intubation, optimize oxygenation, hasten hospital transfer and ventilate patients only in life-threatening circumstances with a supraglottic airway or a bag-valve-mask device. Senior help should be sought early. In a 'cannot ventilate-cannot intubate' situation, a supraglottic airway should be employed and, if ventilation is still unsuccessful, a surgical airway should be performed. Capnography should be used in every ventilated patient. Clinical practice is essential to retain anesthesia and airway management skills.
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The purpose of this review is to focus on recent literature about sedation or anaesthesia in paediatric MRI. Special features of the MRI working environment, recent studies about sedation or anaesthesia, and success rates and risk profiles in this setting are presented. Finally, information for physicians to decide between sedation or anaesthesia in individual situations is presented. ⋯ The MRI unit is a work station where all processes have to be well planned and staff trained to guarantee maximum patient safety, superior quality of imaging and economic needs. For optimal performance trained, experienced and certified personnel, appropriate drugs for the individual patient risk profile and sufficient monitoring equipment are essential.
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Interventions in the cardiac catheterization laboratory (CCL) requiring anaesthetic expertise are becoming routine. These interventions involve a heterogeneous patient population and take place in an offsite location. This review aims to give an insight into anaesthetic issues surrounding certain interventions and the challenges encountered in an offsite location. ⋯ Interventions in the CCL have developed to such an extent that dedicated anaesthesia teams are required in order to cope with the complexities of the patient populations, the interventions and the challenges brought by the offsite nature of the CCL.
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Ketamine has been repeatedly reviewed in this journal but novel developments have occurred in the last few years prompting an update. Interesting recent publications will be highlighted against a background of established knowledge. ⋯ More questions have arisen than have been answered. Some have very grave implications. The issue of neuroapoptosis must be clarified. The long-term effects must be further investigated. On the bright side the effects on postoperative delirium, as well as the anti-inflammatory and antidepressive effects, might open new vistas for an old drug.