Current opinion in anaesthesiology
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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.
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Curr Opin Anaesthesiol · Jun 2016
ReviewThe use of remifentanil during general anesthesia for caesarean section.
The purpose is to review the neonatal and maternal effects of remifentanil given at induction of general anesthesia for caesarean section and prior to delivery of the baby. ⋯ Remifentanil can be safely used at induction of general anesthesia provided healthcare workers are available to manage short-lived neonatal depression.
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This review outlines the challenges in looking after pregnant women with thromboembolism and sepsis who either become or are at risk of becoming critically ill during pregnancy. ⋯ In this review, we discuss the pathophysiology, diagnosis, and management of thromboembolism and sepsis, two very important conditions with high mortality requiring admission to intensive care.
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Airway management and failed intubation in the pregnant woman requires unique considerations, which differ from the nonpregnant patient. Factors that influence airway management in this setting include anatomical and physiological changes in pregnancy, environmental factors as well as training matters. In addition, surgery is often being performed with extreme urgency, which requires rapid decision-making process that takes into account safe outcome of mother and baby. The purpose of this review is to focus on recent developments that address these exceptional airway challenges in obstetrics. ⋯ Recent advances and recommendations in the management of the obstetric airway should help to bring consistency of clinical practice, reduce adverse events, and standardize teaching by providing a structure for teaching and training on failed tracheal intubation in obstetrics. Opportunities during elective caesarean sections and simulation should be used as teaching tools to improve anaesthetists' and team performance during a crisis.