Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2015
ReviewTransfusion and coagulation management in major obstetric hemorrhage.
Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. ⋯ A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.
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Curr Opin Anaesthesiol · Jun 2015
ReviewAnesthesiological considerations for children with obstructive sleep apnea.
To summarize recent evidence-based data regarding outcomes associated with children who have obstructive sleep apnea (OSA). ⋯ Perioperative deaths in children with OSA occur at a low frequency. Hypoxia-induced opioid sensitivity combined with an approximate 1-2% incidence of rapid conversion of codeine to morphine suggest the need for new approaches for providing preoperative assessment of risk, extended postoperative observation and the need for alternative opioids to codeine. Additionally, new less painful surgical approaches may help to reduce postoperative opioid requirements and therefore perhaps less risk for opiate-induced apnea in this vulnerable population.
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The aim of this review is to discuss recent developments in vascular access technology and to highlight those that are particularly relevant to the practitioner. ⋯ Despite the development of new technical devices, successful venous puncture remains heavily dependent on the skills of the operator.
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Neuraxial analgesia is considered the gold standard of labour analgesia as it provides the most effective method of pain relief during childbirth. In this article, we explore the recent advances in the initiation and maintenance of epidural analgesia. ⋯ We examine these recent developments in pump technology and epidural delivery systems and evaluate how these have enhanced the mothers' birthing experiences.
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Curr Opin Anaesthesiol · Jun 2015
ReviewPatient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider.
Remifentanil is a relatively new but commonly used opioid alternative in the management of labor pain relief. The present article evaluates efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief. ⋯ Remifentanil PCIA is a valuable analgesic strategy whenever regional analgesia is contraindicated. Using it as first line strategy seems to be contraindicated because of significant respiratory side-effects to the mother. Whenever used advanced and continuous monitoring using capnography, saturation monitoring and one-to-one midwifery care are mandatory!