Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2015
ReviewIntraoperative hypotension in neonates: when and how should we intervene?
Organ hypoperfusion remains an important cause of postoperative morbidity in neonates. Blood pressure (BP) is frequently mistakenly used as a surrogate of organ perfusion and the predictive value of BP for outcome is unclear. The current article will focus on the role of BP in the optimization of organ perfusion during anaesthesia in neonates. ⋯ Anaesthetic management should focus on optimizing organ perfusion and not merely on maintaining a particular BP. A collaborative approach is recommended. The carbon dioxide tension is crucial to perfusion in the presence of cardiovascular shunts.
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Spinal anesthesia has long been described as a well-tolerated and effective means of providing anesthesia for infants undergoing lower abdominal surgery. Now, spinal anesthetics are being used for an increasing variety of surgeries previously believed to require a general anesthetic. This, along with increasing concerns over the neurocognitive effects of general anesthetics on developing brains, suggests that further exploration into this technique and its effects is essential. ⋯ Early findings of spinal anesthesia exposure in infancy have shown it to have no independent effect on neurocognitive delay as well as to provide sound cardiorespiratory stability. With safer means of administering a spinal anesthetic, such as with ultrasound guidance, it is a readily available and desirable tool for those providing anesthesia to infants.
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Curr Opin Anaesthesiol · Jun 2015
ReviewTo use or not to use hydroxyethyl starch in intraoperative care: are we ready to answer the 'Gretchen question'?
The decision of the European Medicines Agency (EMA) against the use of hydroxyethyl starch (HES)-based volume replacement solutions in critically ill patients has led to a general uncertainty when dealing with HES-based solutions, even though HES-containing solutions can still be used for the treatment of hypovolaemia caused by acute (sudden) blood loss. This review discusses current evidence of the intraoperative use of HES-based solutions. ⋯ The use of 6% HES 130/0.4 in elective surgery patients is associated with reduced fluid accumulation and no clinically relevant difference in bleeding or the rate of acute kidney injury as compared with crystalloid use alone. Current data do not allow a conclusion on mortality. As they provide no benefit, older starch preparations should not be used.
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Curr Opin Anaesthesiol · Jun 2015
ReviewBlood conservation strategies and the management of perioperative anaemia.
Anaemia is a global health problem with particularly high prevalence in the perioperative setting and it can significantly affect the patient outcomes. This review addresses new findings on the significance of anaemia and patient blood management (PBM) strategies to prevent and manage anaemia. ⋯ Despite the high prevalence of anaemia and the significant toll it takes on patients, simple and effective strategies are available to detect, diagnose and treat it.
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Curr Opin Anaesthesiol · Jun 2015
ReviewAspirin in the perioperative period: a review of the recent literature.
The indications for aspirin (ASA) for both primary and secondary prevention of thrombotic events continue to evolve. We review some of these indications and the recent literature regarding the perioperative administration of ASA. ⋯ The continuation or discontinuation of ASA perioperatively remains a complicated issue. Further, well designed trials are needed for additional clarification.