Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2012
ReviewEpidural analgesia and maternal fever: a clinical and research update.
Maternal fever following epidural analgesia complicates up to one-third of nulliparous labors. Although generally benign, maternal fever is associated with both excess healthcare costs and an increased risk of adverse maternal and neonatal outcomes; therefore, this topic is of interest to anesthesiologists, obstetricians and pediatricians alike. The purpose of this review is to examine the latest research on the topic of epidural-related maternal fever, with special focus on the clinical relevance of new information. ⋯ Significant research advances were made in the last 18 months around the topic of epidural-related fever, but major gaps in knowledge persist especially with understanding the precise mechanism. The most pressing area of research is the development of well tolerated and effective prophylactic interventions to prevent maternal and fetal exposure to hyperthermia and inflammation.
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The use of simulation in medicine has grown significantly over the past 2 decades. Simulation in obstetric anesthesia can be divided into four broad uses: technical skills, nontechnical or teamwork skills, individual clinical competence, and the safety of the clinical environment. This review will describe recent trends in the use of simulation in several of these categories. ⋯ As the use of simulation continues to grow, research should concentrate on whether anesthesia or teamwork skills learned in the simulated environment change behavior and improve outcomes in the clinical setting. More instructional publications would also facilitate the growth into more clinical environments.
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Curr Opin Anaesthesiol · Jun 2012
ReviewPreoperative evaluation, premedication, and induction of anesthesia in infants and children.
Preparation for and induction of anesthesia in children has evolved significantly over the last decade, with particular reference to the reduction of perioperative anxiety reduction by nonpharmacologic and pharmacologic means. Several new large population studies and meta-analyses further scrutinize the current techniques. ⋯ Larger studies still need to be conducted before wide-scale application of many nonpharmalogical interventions such as parental acupuncture. Similarly, more investigation should be done on outcomes such as onset, emergence, and discharge times, as well as the postoperative response with reference to emergence delirium and postoperative nausea and vomiting prevention to outline the differences among sedative premedications such as midazolam, clonidine, and dexmedetomidine.
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Curr Opin Anaesthesiol · Jun 2012
ReviewAnesthetic management in patients undergoing hyperthermic chemotherapy.
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an important therapeutic option for selected patients with peritoneal surface malignancies. This aggressive multimodality treatment is complex, not only regarding surgical technique, but also regarding anesthesia. The present review represents our experience in anesthetic care. ⋯ Anesthetic management importantly contributes to the containment of the perioperative complications of HIPEC. An appreciation of the technical aspects and physiologic disruptions associated with intra-abdominal HIPEC is critical to ensure effective anesthetic management. Although data on this specialized surgical procedure are scarce, some referral centers have accumulated extensive experience. This article reviews the current knowledge about the anesthesiological and intensive care management of patients undergoing HIPEC. It pinpoints strategies for perioperative monitoring as well as illustrates alterations in hemodynamic, hematopoetic, and fluid hemostasis.