Current opinion in anaesthesiology
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Chronic kidney disease (CKD) is an increasing health problem worldwide and is associated with a number of clinical challenges. In this paper, we review recent studies that deal with strategies for the management of patients with CKD undergoing surgery. ⋯ Identification and risk stratification is crucial for the perioperative management of patients with CKD. To improve clinical outcomes, nonemergent procedures should be postponed, renal function optimized, nephrotoxic drugs avoided, and AKI prevented.
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This article provides the reader with recent findings on the pathophysiology of comorbidities in the obese, as well as evidence-based treatment options to deal with perioperative respiratory challenges. ⋯ Anesthesia of obese patients for nonbariatric surgical procedures requires knowledge of typical comorbidities and their respective treatment options. Apart from cardiovascular diseases associated with the metabolic syndrome, awareness of any pulmonary dysfunction is of paramount. A multimodal analgesia approach may be useful to reduce postoperative pulmonary complications.
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Managing the bleeding pediatric patient perioperatively can be extremely challenging. The primary goals include avoiding hypotension, maintaining adequate tissue perfusion and oxygenation, and maintaining hemostasis. Traditional bleeding management has consisted of transfusion of autologous blood products, however, there is strong evidence that transfusion-related side-effects are associated with increased morbidity and mortality in children. Especially concerning is the increased reported incidence of noninfectious adverse events such as transfusion-related acute lung injury, transfusion-related circulatory overload and transfusion-related immunomodulation. The current approach in perioperative bleeding management of the pediatric patient should focus on the diagnosis and treatment of anemia and coagulopathy with the transfusion of blood products only when clinically indicated and guided by goal-directed strategies. ⋯ This article will highlight current guidelines in perioperative bleeding management for our most vulnerable pediatric patients with emphasis on individualized targeted intervention using point-of-care testing and specific coagulation products.
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Curr Opin Anaesthesiol · Jun 2016
ReviewRobotic surgery and anesthesia for pediatric urologic procedures.
Minimally invasive approaches to pediatric surgery have become increasingly popular over the last 15 years. With the advent of robotically controlled instruments, common pediatric urologic surgeries such as pyeloplasty and ureteral reimplantation, which were previously technically challenging, are now commonly performed laparoscopically. It is important to recognize the unique physiologic considerations with this approach and how to provide safe and effective anesthesia for these procedures. ⋯ Robot-assisted laparoscopic surgery is increasingly utilized for common pediatric urologic surgeries. To provide safe and effective anesthesia for this type of surgery, it is important to have a thorough understanding of the multiple physiologic derangements that occur with robot-assisted laparoscopic surgery in infants and children, the potential complications that can occur with this approach and have a consistent approach to the anesthetic management and postoperative pain control for these procedures.
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Curr Opin Anaesthesiol · Jun 2016
ReviewDiagnosis and treatment of obstructive sleep apnea during pregnancy.
This review aims to provide an update on recent advances in the diagnosis and treatment of obstructive sleep apnea (OSA) during pregnancy and its effect on maternal and fetal outcomes. ⋯ Further research is needed to help in the detection and treatment of OSA in pregnancy.