Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2020
ReviewHypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy.
Hypotension during cesarean section remains a frequent complication of spinal anesthesia and is associated with adverse maternal and fetal events. ⋯ Current evidence favors a combined approach of low-dose spinal anesthesia, adequate fluid therapy and vasopressor support to address maternal spinal-induced hypotension. As none of the available vasopressors is associated with relevantly impaired maternal and fetal outcomes, none of them should be abandoned from obstetric practice. Rapid crystalloid co-loading is of equivalent efficacy as compared with colloids and should be preferred because of a more favorable risk profile.
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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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The objective of this review is to identify the potential of peripheral nerve blocks established over the last years for perioperative pain management in breast surgery. These new blocks will be discussed with respect to their clinical effect and necessity. ⋯ Taking the pain levels after breast surgery into account, the request of additional nerve blocks has to be pondered against the potential risks and resource requirement. To reduce or avoid intraoperative or postoperative opioids, an ultrasound-guided Pecs II block proves to be the best option for perioperative pain relief.
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Curr Opin Anaesthesiol · Jun 2020
ReviewConjoined twins in 2020 - state of the art and future directions.
A number of high profile conjoined twin separations have been extensively covered by the world media. Anaesthesia for conjoined twins is a procedure rarely experienced by paediatric anaesthetists. The increased survival of the twins has prompted discussion as to the most appropriate selection of patients, teams and hospitals to provide exceptional anaesthetic care. ⋯ There appears to be an expanding role for international teams with extensive separation experience becoming involved in international teleconferencing to improve patient management in low-resource countries. Whether the perioperative outcome is better when the conjoined twins are transferred to major centres for surgery or teams operate in the twin's country of origin remains to be seen.
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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.