Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2019
ReviewThe patient with hypertension and new guidelines for therapy.
Hypertension is a leading disease in preoperative clinics; nearly 60% of patients over 60 years have it. Many guidelines have been published for the diagnosis and treatment of hypertension. Last year, the American College of Cardiology/American Heart Association and European Society of Cardiology and European Society of Hypertension made new recommendations for diagnosis and management, with special emphasis on targets, nonpharmacological treatment, and management of the elderly patient, and pharmacological therapy. We will review relevant concordances and differences that are important for the anesthesiologist and perioperative management. ⋯ New guidelines could increase the burden of patients with pharmacological treatment that will need surgery and require case by case considerations. The scarcity of information demands trials about blood pressure management and consensus about antihypertensive medications in perioperative period.
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Curr Opin Anaesthesiol · Jun 2019
Reducing breakthrough pain during labour epidural analgesia: an update.
Neuraxial techniques are the current gold standard for labour analgesia, but are associated with up to 25% incidence of breakthrough pain. In this review, we aim to update clinicians on the latest research pertaining to the optimization of neuraxial labour analgesia. ⋯ Recent advances in combined spinal epidural, DPE, automated mandatory bolus, and individualized therapies have advanced our goal of providing effective labour analgesia that is titrated to changing analgesic requirements during labour and delivery and reducing breakthrough pain.
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An exploration of the ethics, challenges and practical reality of treating family members. Hutchison & McConnell deploy models of virtue, utilitarianism, deontology and principlism in an accessible and applied way.
- Virtue ethics – behaving in the way we think is right; embodying courage.
- Utilitarianism – behaving so as to maximise the best outcomes for the greater number of people.
- Deontology – obeying the rules; following a duty to moral law.
- Principlism – balances beneficence, nonmaleficence, autonomy and justice.
They cautiously challenge the blanket prohibitions of many professional bodies against treating family members.
Well worth reading.
summary“Only by constantly questioning whether they are the correct person to deliver care can they hope to do right by both their relative and themselves.”
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Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. ⋯ To improve conveyance of an individual's wishes for end-of-life care, the authors discuss nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers. Facial recognition software could identify unconscious patients who present without identification.