Current opinion in anaesthesiology
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Distress in children during hospitalization is increasingly seen as unacceptable and preventable. Surgery and anaesthesia are distressing events for children with maximum stress at induction of anaesthesia. This review aims to report the recent research relevant to reducing this distress in children with a focus on the preoperative period and the impact of this on behaviour at induction and long-term postoperatively. ⋯ New measures of anxiety will facilitate better evaluation of children clinically and better future research. The role of α2-adrenergic agonists in premedication remains unclear. There is still little research, which examines outcomes for techniques for minimizing distress, which are based on specific assessment of the child and family.
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Curr Opin Anaesthesiol · Jun 2011
ReviewAnesthetic considerations for the patient undergoing therapy for advanced heart failure.
Advanced heart failure (AHF) affects a growing percentage of our population. The anesthesiologist must be cognizant of the perioperative considerations of patients undergoing state-of-the-art therapy for AHF. These therapies include classic and novel agents to improve systolic function, neurohormonal modulators, heart rhythm and synchronization management and mechanical support of the circulation. The perioperative considerations and recommendations may range from invasive hemodynamic monitoring, management of proper inotropic support to maintain left ventricular and right ventricular systolic function, isolation from electromagnetic interference in patients with rhythm management devices, maintenance of appropriate systemic and pulmonary vascular resistance, and surgical planning and anticoagulant management. ⋯ A working knowledge of AHF treatments and perioperative considerations is necessary for all anesthesiologists as more patients receiving therapy will be presenting for all types of surgical procedures.
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The aim of this review is to outline the priorities in the anaesthetic management of the child with facial abnormalities. It presents a practical approach to this, based on the anatomical site of the deformity and degree of mouth opening. ⋯ This is a challenging area of anaesthetic practice but the use of a structured approach, combined with supraglottic airway devices and fibre-optic and indirect laryngoscopic equipment, has allowed the safe administration of anaesthesia to almost all children with conditions resulting in facial abnormality.
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This review focuses on difficult intubation in pregnant patients, particularly during the late pregnancy when physiological, patho-physiological and psychological factors may cause or aggravate difficulties with providing sufficient oxygenation and securing the airway. It is intended to highlight the methodological approach to the difficult airway in this particular patient population and to draw relevant principles in dealing with this problem. ⋯ A scenario-oriented approach to the problem of difficult intubation in pregnant patients leads to the recognition of the unpredicted difficult or failed intubation as the main concern. The appropriate means to cope with this rare but life-threatening complication lies in a gradual employment of principles beginning with preferential application of regional anaesthesia techniques, followed by proceeding according to locally adapted simple and comprehensive failed intubation algorithms, design of a suitable difficult airway cart that contains only a few but well chosen items and by implementation of a continuous and mandatory training program to which all personnel are subjected to participate in regular intervals.
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Curr Opin Anaesthesiol · Jun 2011
ReviewOxytocin for labour and caesarean delivery: implications for the anaesthesiologist.
The implications of the obstetric use of oxytocin for obstetric anaesthesia practice are summarised. The review focuses on recent research on the uterotonic effects of oxytocin for prophylaxis and management of uterine atony during caesarean delivery. ⋯ Oxytocin remains the first-line uterotonic after vaginal and caesarean delivery. Recent research elucidates the therapeutic range of oxytocin during caesarean delivery, as well as receptor desensitization. Evidenced-based protocols for the prevention and treatment of uterine atony during caesarean delivery are recommended.