Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2017
ReviewComplications and unplanned admissions in nonoperating room procedures.
The purpose of this article is to review complications and unplanned hospital admissions in patients presenting for ambulatory procedures requiring anesthesia care in the gastrointestinal endoscopy, bronchoscopy, and radiology suites. ⋯ Sedation and anesthesia are required for the increasing number of increasingly complex procedures being undertaken outside the operating suite. Large randomized trials are required to define the optimum sedation drugs, sedation depth and sedation provider.
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Curr Opin Anaesthesiol · Dec 2017
ReviewOptimizing education in difficult airway management: meeting the challenge.
The last 2 decades have seen a vast change in the science and technology of airway management. As a result, there is an increasing need to equip anesthesiologists with the new knowledge and skills for the safe management of a difficult airway. ⋯ There is need for research on difficult airway management and optimized training methods. Research is also required to determine the barriers to adoption of guidelines and strategies to ensure widespread dissemination and implementation of guidelines and best practices for difficult airway management.
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Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. ⋯ Epidural analgesia for obstetric analgesic purposes is considered to be well tolerated in young, healthy women, since efficacy has been proven and complications leading to permanent neurological damage seldomly occur. Safety of epidural analgesia for perioperative and chronic pain treatment is more difficult to balance; careful selection of appropriate patients cannot be over-emphasized.
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Curr Opin Anaesthesiol · Dec 2017
ReviewClinical update regarding general anesthesia-associated neurotoxicity in infants and children.
The U.S. Federal Drug Administration (FDA) recently released a warning stating that 'repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains' (www.fda.gov/ucm582356.htm). The goal of this article is to review the most recent clinical studies which provide evidence that these concerns may be overstated for the majority of healthy young children who require surgery and anesthesia. ⋯ These findings suggest that anesthetic neurotoxicity is not a major contributory pathway for adverse neurodevelopmental outcomes in the majority of healthy children who require surgery before 3 years of age. Future work should focus on the particular vulnerabilities of the fetus, premature infant, and children with developmental disabilities, major congenital, cardiac or neurological abnormalities not specifically addressed by these studies.
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Curr Opin Anaesthesiol · Dec 2017
ReviewHeart rate variability: implications for perioperative anesthesia care.
Heart rate variability (HRV) is a measure of the balance between both the parasympathetic and sympathetic nervous system and may provide useful information for anesthesia care providers. HRV may offer predictive information about critically ill and operative patients. Further, HRV collection provides real-time information of patient autonomic nervous system status and may allow tailoring of the analgesia for patients in the ICU and operating room. ⋯ Not applicable.