Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2020
ReviewPreoperative considerations for Jehovah's Witness patients: a clinical guide.
Jehovah's Witnesses have religious beliefs that preclude transfusion of blood products and certain medical interventions. This presents a unique dilemma and ethical challenge to healthcare providers, especially in a surgical setting. ⋯ Anticipating the challenges associated with managing and optimizing patients who refuse blood products allows for more favorable outcomes in the preoperative period.
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Curr Opin Anaesthesiol · Jun 2020
ReviewPoint-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory.
This review focuses on the use of point-of-care ultrasound (PoCUS) in the obstetric context for airway management and assessment of aspiration risk, the placement of neuraxial blocks and the diagnosis and follow-up of cardiorespiratory dysfunction. ⋯ Owing to its noninvasiveness, ease of accessibility and lack of exposure to radiation, PoCUS plays an increasing and essential role in aspiration risk assessment, airway management, neuraxial anaesthesia and cardiorespiratory diagnosis and decision-making during pregnancy.
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Curr Opin Anaesthesiol · Jun 2020
ReviewUpdates in periprocedural management of direct oral anticoagulants.
As the prevalence of patients on antithrombotics is increasing, anesthesiologists must have a firm understanding of these medications and considerations for their periprocedural management. This review details up-to-date periprocedural management of direct oral anticoagulants (DOACs). ⋯ With the exception of no clinically relevant bleeding risk or certain electrophysiology procedures, DOACs should be discontinued periprocedurally in accordance with bleeding risks and drug's half-life. Bridging is generally not recommended for DOACs.
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Curr Opin Anaesthesiol · Jun 2020
ReviewFetal anesthesia: intrauterine therapies and immediate postnatal anesthesia for noncardiac surgical interventions.
This review describes maternal and fetal anesthetic management for noncardiac fetal surgical procedures, including the management of lower urinary tract obstruction, congenital diaphragmatic hernia (CDH), myelomeningocele, sacrococcygeal teratoma, prenatally anticipated difficult airway and congenital lung lesions. ⋯ Maternal and fetal anesthetic management is tailored to the fetal intervention and the underlying health of the fetus and mother.
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Curr Opin Anaesthesiol · Jun 2020
ReviewAnesthesia teams managing pacemakers and ICDs for the perioperative period: enhanced patient safety and improved workflows.
There have been both technological and philosophical advances over the last decade regarding pacemakers and implanted cardioverter defibrillators (ICDs). Collectively, these devices are currently referred to as cardiac implantable electronic devices (CIEDs). Technological advances include the introduction of leadless pacemakers, subcutaneous defibrillators and cardiac event recorders, enhancements regarding compatibility of CIEDs for MRI scanning, the ability to interrogate devices remotely, and improved programming modes that preserve battery life. Philosophical advances have been mainly in the area of perioperative management of CIED patients. ⋯ Educated anesthesia teams can independently manage the vast majority of CIED patients perioperatively with magnet application alone. Furthermore, this portends enhanced patient safety and improved workflows in the perioperative period.