Current opinion in anaesthesiology
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The aim of this review is to underline the need for an adequate clinical and functional evaluation of respiratory function and asthma control in patients undergoing surgical procedures requiring general anesthesia to obtain useful information for an adequate preoperative pharmacological approach. ⋯ A better control of asthma must be considered the 'gold standard' for a patient at 'a reasonable low risk' to develop perioperative/postoperative bronchospasm. International consensus promoted by pulmonologists, anesthesiologists, and allergists might be useful to define a better diagnostic and therapeutic approach.
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Curr Opin Anaesthesiol · Feb 2012
ReviewStrategies to reduce the use of blood products: a US perspective.
To describe the recent developments in the strategies to reduce allogeneic blood transfusions with emphasis on the impact on clinical outcomes. ⋯ Patient blood management is the timely use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcome.
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There is a large variation in the methods and techniques used to secure the airway in children for the purposes of diagnosis and surgery. This review gives an idea of the different ways through which this can be achieved. ⋯ There is still no consensus on how to manage these patients. Each centre has evolved a system that works for them. However, the common themes of communication between team members, attention to detail and a high level of awareness of problems run through all the articles quoted here.
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Curr Opin Anaesthesiol · Dec 2011
ReviewManagement of postdischarge nausea and vomiting after ambulatory surgery.
Although there are extensive studies of postoperative and postdischarge nausea and vomiting (PONV/PDNV) up to 24 h, few investigate 'delayed PDNV'. With an increasing outpatient surgical population, specific 'delayed PDNV' risk identification and management is necessary for improving outcomes and helping patients after discharge. This review will discuss possible PDNV specific risk factors, successful prevention and management of PDNV following ambulatory anesthesia and the principles and pharmacology of these interventions. ⋯ Further PDNV specific research is needed, including PDNV predictive models in directing antiemetic interventions. Long-acting antiemetics and postdischarge oral antiemetics are effective in PDNV pharmacologic management. Neurokinin-1 receptor antagonists are effective in reducing the incidence of vomiting, but not nausea. The addition of nonpharmacologic interventions such as acustimulation may reduce PDNV. Multimodal analgesia including nonopioid analgesics and ambulatory continuous peripheral nerve blocks are encouraged to achieve adequate postoperative analgesia and reduce opioid induced PDNV.