Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2016
ReviewAnaesthesia and global health initiatives for children in a low-resource environment.
As the United Nations moves from Millennium Development Goals to Sustainable Development Goals, we find ourselves with the opportunity to influence the priority of global health initiatives. Previously, the global health community has failed to recognise the importance of access to safe, affordable surgery and developing the necessary specialities that support it as most of the funding focus had been on primary healthcare and infectious diseases. ⋯ Although there is increased world interest in safe surgery and anaesthesia this has not yet been translated into a mandate that will compel countries to invest in improving levels of infrastructure, accessibility, manpower, and safety. A general anaesthetic remains a dangerous event in a child's life in resource-limited countries.
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Curr Opin Anaesthesiol · Jun 2016
ReviewAnesthetic considerations for pediatric obesity and adolescent bariatric surgery.
Pediatric obesity has become commonplace in our clinical practice, and presents anesthesia providers with numerous challenges. This study provides an up-to-date review of their perioperative care, including the measurement of pediatric obesity, rational drug dosing in obese children, and recent data on bariatric outcomes in adolescents. ⋯ Safe and effective care of obese children demands careful perioperative management. High risk children are particularly vulnerable, and demand special attention. Bariatric surgery is an effective intervention for adolescents with severe obesity.
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Curr Opin Anaesthesiol · Jun 2016
ReviewDoes major surgery induce immune suppression and increase the risk of postoperative infection?
Infection is the commonest cause of a postoperative complication. Following major surgery alterations in immune function are commonplace and these may contribute to an enhanced susceptibility to acquire nosocomial infections. This review will discuss postoperative infections in the context of an altered perioperative immune response and the factors influencing this response. ⋯ Point of care tests are emerging that allow monitoring of the perioperative immune response. These could be further developed to introduce personalised care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that may be associated with poor outcomes through immune modulation.
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Obstetric anesthesiologists are supposed to understand the uterotonics and tocolytics used in the perinatal period to provide a better clinical practice. This review describes current consensus of uterotonics and tocolytics used in the perinatal period that an obstetric anesthesiologist should know. ⋯ Anesthesiologists involved in obstetric anesthesia should be able to determine the appropriate uterotonic for cesarean section and know the indication of tocolytics in perinatal period.
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Curr Opin Anaesthesiol · Jun 2016
ReviewThe impact of glycaemic variability on the surgical patient.
Diabetes is the most prevalent long-term metabolic condition and its incidence continues to increase unabated. Patients with diabetes are overrepresented in the surgical population. It has been well recognized that poor perioperative diabetes control is associated with poor surgical outcomes. The outcomes are worst for those people who were not recognized as having hyperglycaemia. ⋯ glycaemic control remains an important consideration in the surgical patient.