Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Jun 2018
ReviewPediatric anesthesia after the anaesthesia practice in children observational trial study: who should do it?
This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. ⋯ The main factors that likely contributed to the APRICOT study results are discussed with the goal of defining clear requirement guidelines for anesthetizing children. Emphasis is placed on the importance of an incident-reporting system that can be used for both competency-based curriculum for postgraduate training as well as for continuous professional development. Variability in training as well as in available resources, equipment and facilities limit the generalization of some of the APRICOT results. Finally, the impact on case outcome of the total number of pediatric cases attended by the anesthesiologist should be taken into consideration along with the level of expertise of the anesthesiologist for complex pediatric anesthesia cases.
-
Curr Opin Anaesthesiol · Jun 2018
ReviewA different perspective: anesthesia for extreme premature infants: is there an age limitation or how low should we go?
To put in perspective, the various challenges that faces pediatric anesthesiologists because of the recently lowered limits with regards to the viability of a fetus. Both medical and ethical considerations will be highlighted. ⋯ There does currently not exist sufficient research data to provide any evidence-based guidelines for the anesthetic handling of extreme premature infants. Current practice relies on extrapolations from other patient groups and from attempting to preserve normal physiology. Thus, focused research initiatives within this specific field of anesthesia should be a priority. Furthermore, in-depth multiprofessional ethical discussions regarding long-term outcome of aggressive care of extremely premature babies are urgently needed, including the new concepts of disability-free survival and number-need-to-suffer.
-
Curr Opin Anaesthesiol · Jun 2018
ReviewIntraoperative blood pressure levels in young and anaesthetised children: are we getting any closer to the truth?
Blood pressure is a basic feature of monitoring during anaesthesia. However, it is very unclear what blood pressures are normal during anaesthesia in children. Furthermore, the clinical consequences of low blood pressure are also uncertain. Similarly, it is unclear when to initiate therapy for hypotension during anaesthesia. This review summarizes the most recent development on the interpretation of blood pressure measurements in children and the relation of low blood pressure to clinical outcome. ⋯ The recently published reference tables can guide anaesthesiologist in daily practice to define intraoperative hypotension. However, there are situations in which a higher blood pressure is recommendable and an individual approach is required.
-
Curr Opin Anaesthesiol · Jun 2018
ReviewClinical pearls part 3: anaesthetic management of abnormally invasive placentation.
Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. ⋯ A robust protocol outlining the key elements of the management of placenta accreta, including optimizing postoperative care, should be in place to promote desired outcomes.
-
Curr Opin Anaesthesiol · Jun 2018
ReviewAcute pain management in children: challenges and recent improvements.
The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain. ⋯ Treatment options have evolved in recent years, including the combinations of multimodal regimens and regional anesthetic techniques. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids.