Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2013
ReviewAnesthetic-related neurotoxicity in young children: an update.
This review examines the recent data, animal and human, reporting an association between early anesthetic exposure, neuronal cell death, and adverse neurocognitive and behavioral outcomes. ⋯ Although the evidence from nonhuman primates and humans is overtly concerning, it lacks clinical verification. There are, at present, no data that would dictate a change in clinical practice in the anesthetic management of infants and children.
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Curr Opin Anaesthesiol · Jun 2013
ReviewFluid therapy in critical illness: a special focus on indication, the use of hydroxyethyl starch and its different raw materials.
Fluid therapy is a complex intervention with insufficient resuscitation, as well as overinfusion and fluid accumulation being associated with adverse outcomes. Early goal-directed therapy with later conservative fluid management (i.e. prevention of positive fluid balance and weight gain) appears to markedly improve the survival of patients with severe sepsis. The impact of colloids in resuscitation of patients with sepsis has been the topic of several recently published studies. The purpose of the present review is to outline the indication of fluid administration in critically ill patients, discuss the recent findings of trials involving hydroxyethyl starch (HES) solutions and highlight the impact of different raw materials for HES synthesis. ⋯ Adverse effects of fluid resuscitation in critically ill patients appear to be a consequence of dose and timing rather than the type of fluid itself. Modern waxy maize-derived 6% HES 130/0.4 may have advantages over crystalloids in the very early course of the disease. Clinical trials of early, goal-directed and protocolized therapy with innovative endpoints of resuscitation comparing balanced crystalloids and balanced, waxy maize-derived 6% HES 130/0.4 as the initial resuscitation fluid are warranted.
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Curr Opin Anaesthesiol · Jun 2013
ReviewRole of transversus abdominis plane block after caesarean delivery.
The transversus abdominis plane (TAP) block is a relatively new regional anaesthesia technique that has shown analgesic benefit in abdominal and pelvic surgery. There has been recent interest in expanding this regional technique to enhance analgesia following caesarean delivery. ⋯ The TAP block significantly improves postoperative analgesia and reduces opioid consumption and opioid-related side-effects in women undergoing caesarean delivery who did not receive intrathecal morphine.
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Perioperative visual loss (POVL) is an uncommon complication primarily associated with cardiac, spine, and head and neck surgery that can have a potentially severe impact on quality of life. The largest multicenter case control study to date on POVL recently identified risk factors associated with ischemic optic neuropathy and prone spinal fusion surgery. This review will summarize these findings and the updated American Society of Anesthesiologists practice advisory on POVL to provide guidance on identification and management of high-risk patients undergoing prone spine surgery. Epidemiology data on POVL from national databases, POVL in robotic surgery, and posterior reversible encephalopathy syndrome as a newer cause of POVL will also be discussed. ⋯ Strategies aimed at modifying risk factors for ischemic optic neuropathy associated with prone spinal fusion surgery that are extrinsic to the patient may decrease its incidence. Further research is needed to validate this concept.