Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthetic management of transcatheter aortic valve implantation.
The revolution in transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis has been well described by the large number of randomized trials, registries, and single and multicenter experiences published during 2010-2011. The aim of this review is to describe the challenges of the anesthetic management related to TAVI. ⋯ Preprocedural, multidisciplinary assessment of the patient is essential prior to TAVI and should include a full anesthetic evaluation, consideration of patient comorbidities, and determination of technical feasibility. The role of scoring systems for risk prediction requires further scrutiny. Multidevice/multiple access approaches allow for treatment of a wide range of patients. Anesthetic techniques and supportive measures vary depending on procedural concerns, patient comorbidity, and severe, often unstable cardiac disease. Echocardiography is fundamental to preoperative evaluation, procedure guidance, and assessment of complications. Planned bailout strategies should be discussed with all members of the medical team. Postoperative standardized monitoring and management protocols are essential.
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Curr Opin Anaesthesiol · Aug 2011
ReviewSedation and anesthesia for the pediatric patient undergoing radiation therapy.
Radiation oncology is a cornerstone in the treatment of cancer in children. Although painless, there is a requirement for the child to lie still by themselves in the radiation treatment room, for multiple daily or twice daily treatments for up to 6 weeks. Anesthesia or sedation is usually necessary to achieve this in younger children. This review provides a brief update of the latest developments in radiation oncology and describes the current best practice in anesthesia for these children. ⋯ In the vast majority of cases, total intravenous anesthesia or sedation using propofol ensures that the child remains immobile, whilst maintaining spontaneous respiration, an unobstructed airway, and cardiovascular stability.
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To review the recent literature on the implications of occupational radiation exposure in anesthesia practice. ⋯ Radiation is increasingly utilized in medicine for diagnostic and therapeutic procedures. Anesthesia providers may become exposed to unsafe doses while providing high-quality patient care. Understanding of the physical principles, the sources of radiation exposure, the potential risks, and safe practices helps to minimize the exposure risk and its potential deleterious effects to the anesthesia team.
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Advances in health information technology and broadband Internet connections provide novel opportunities for anesthesiologists to extend perioperative consultation services to remote geographic areas. Increasing economic pressures on healthcare delivery systems make initiatives such as telemedicine, which reduce costs while achieving excellent outcomes, an attractive option. ⋯ Anesthesiologists have the opportunity to develop telemedicine programs that can improve the delivery of care to patients. Current programs offer services ranging from remote preoperative evaluation to international collaboration for intraoperative management and consultation. Simulation using telemedicine services can provide educational opportunities and test the effectiveness of institutions' communications systems.
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Interventional neuroradiology is a rapidly expanding speciality. The aim of this review is to provide the anaesthetist with an up-to-date summary of current and future advances in interventional neuroradiology. ⋯ Providing safe care to patients in the remote radiology suite requires a clear understanding of the complexity of procedures being undertaken, potential complications and careful, thorough assessment of patients.