Current opinion in anaesthesiology
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Hypoxic-ischemic brain injury is a leading cause of mortality and morbidity in neonates. Treating such injury by interrupting the excitotoxic-oxidative cascade is of immense importance. This review will focus on novel techniques of neuroprotection and describe the latest advances in established therapeutic methods. ⋯ Significant advances have occurred in the management of neonatal brain injury. With establishment of the optimal temperature and duration of hypothermia, combinatory therapies using adjuncts hold the greatest promise. Promising preclinical approaches such as stem cell-based therapy and use of noble gases need to be confirmed with clinical trials.
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The expected difficult airway in children is a rare, but predictable entity, which can lead to life-threatening situations, when sufficient oxygenation and ventilation cannot be achieved. This review gives an overview on current techniques and recommendations on where, who, when, and how to treat children with expected difficult airway. ⋯ The expected difficult airway in children is predictable by clinical signs and medical history in most of the cases and therefore anticipative. It should always be managed in specialized centers. In emergency situations, optimized face mask ventilation (aided by an oropharyngeal/nasopharyngeal airway) or ventilation via supraglottic airway devices or a nasopharyngeal tube can be most helpful skills until definitive airway management is available. These emergency techniques should be taught regularly in all anesthesia departments where children present for elective and nonelective surgery.
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Pre-operative oral carbohydrate decreases postoperative insulin resistance, speeds gastrointestinal functional recovery and reduces hospital stay, most significantly after major surgery.
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Curr Opin Anaesthesiol · Jun 2015
ReviewAnesthesiological considerations for children with obstructive sleep apnea.
To summarize recent evidence-based data regarding outcomes associated with children who have obstructive sleep apnea (OSA). ⋯ Perioperative deaths in children with OSA occur at a low frequency. Hypoxia-induced opioid sensitivity combined with an approximate 1-2% incidence of rapid conversion of codeine to morphine suggest the need for new approaches for providing preoperative assessment of risk, extended postoperative observation and the need for alternative opioids to codeine. Additionally, new less painful surgical approaches may help to reduce postoperative opioid requirements and therefore perhaps less risk for opiate-induced apnea in this vulnerable population.
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The aim of this review is to discuss recent developments in vascular access technology and to highlight those that are particularly relevant to the practitioner. ⋯ Despite the development of new technical devices, successful venous puncture remains heavily dependent on the skills of the operator.