Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Jun 2019
ReviewPharmacokinetic-pharmacodynamic population modelling in paediatric anaesthesia and its clinical translation.
Pharmacokinetic-pharmacodynamic (PKPD) population modelling has advanced adult anaesthesia. Current literature was reviewed to discern use of this analytic technique for benefit in the perioperative management of children. ⋯ Modelling and simulation continue to have an important role optimizing drug use during anaesthesia. Models incorporating influential covariates that better describe drug pharmacokinetics and pharmacodynamics improve anaesthetic treatments and safety in diverse populations and clarify drug role and impact. Their use developing paediatric clinical studies improves trial conduct, often with fewer subjects required for study.
-
With new medical technologies and changing life styles, maternal demographics has changes and consequently older and sicker women are becoming pregnant.In this review, we present these different high-risk parturient populations, which were once considered rare for the practicing obstetric anesthesiologist. ⋯ Future research and implementation of international guidelines for management of these high-risk parturient population is necessary in order to reduce maternal and neonatal morbidity.
-
There has been a steady advance in neuromonitoring during anaesthesia. Inevitably much of the research is first done in adults and later in children. This review will focus on the recent paediatric publications (2017-2019) in two areas of neuromonitoring - measuring anaesthesia effect and cerebral perfusion and oxygenation. ⋯ The impact of anaesthesia on the EEG of small infants has some gross similarities to older children but there are fundamental differences, which mandate separate calibration of anaesthesia depth monitors. The role of nociception monitors in children has yet to be defined. Cerebral oxygenation monitoring during paediatric anaesthesia is improving our understanding of cerebral perfusion in this period, but as with almost all monitoring, evidence that its use improves outcome is not yet available.
-
Curr Opin Anaesthesiol · Jun 2019
ReviewIs opioid-free general anesthesia for breast and gynecological surgery a viable option?
Opioid-free general anesthesia is a viable anesthetic technique for breast and gynecological surgery.
pearl -
Curr Opin Anaesthesiol · Jun 2019
ReviewEpidural test dose in obstetric patients: should we still use it?
As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue. ⋯ Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended-low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a 'traditional' test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.