Current opinion in anaesthesiology
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Cardiomyopathy is an important cause of heart failure and a major indication for heart transplantation in children. Unfortunately, there is a paucity of literature to guide the anesthesiologist who cares for these high-risk children. This review describes the cardiomyopathy phenotypes that occur in children and the factors that are associated with clinical outcomes and perioperative complications. Anesthesia considerations will be reviewed. ⋯ The diverse spectrum and complexity of pediatric cardiomyopathies mandate a thorough appreciation of the cardiac pathophysiology pertinent to an individual child's perioperative management. Important issues include multisystem disease associated with syndromic or genetic disorders, appropriate preoperative patient assessment to adequately characterize patient risk and guide therapy, and intraoperative and postoperative care plans that target optimal outcomes.
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Although millions of parturients profit from neuraxial analgesia for labor, there are far more of those who do not have this choice for one reason or another. They need alternative ways to relieve labor pain. ⋯ Paracervical block with modern technique is a viable option for selected cases. It is rapid and does not affect the course of labor, but its efficacy is only modest. Pudendal block can be used in the second stage of labor or for episiotomy tear repair and pain. Intravenous remifentanil is currently becoming an established method, although its safety is still an issue. Nitrous oxide is a useful method to be used alone or together with the other methods.
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Curr Opin Anaesthesiol · Jun 2011
ReviewAnesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage.
Placenta accreta is one of the leading causes of peripartum hemorrhage. The goal of this article is to review anesthetic management of parturients with placenta accreta and to examine a modern approach to massive peripartum hemorrhage. ⋯ Careful planning and close communication are essential between anesthesiology, obstetric, interventional radiology, gynecologic oncology, blood bank, and specialized surgical teams when taking care of a patient with placenta accreta.
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The developing brain is particularly vulnerable to traumatic brain injury (TBI), leading to frequent disability or death. This article is an update of the pediatric specificities of TBI management. ⋯ Many therapeutic modalities in pediatric TBI have a low level of evidence. Further research is needed to establish clear resuscitation goals. Universal objectives may not be suitable for all patients; intensive neuromonitoring may help in identifying individual therapeutic goals and guiding the selection of treatments.