Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2011
ReviewAnesthetic management of patients with placenta accreta and resuscitation strategies for associated massive hemorrhage.
Placenta accreta is one of the leading causes of peripartum hemorrhage. The goal of this article is to review anesthetic management of parturients with placenta accreta and to examine a modern approach to massive peripartum hemorrhage. ⋯ Careful planning and close communication are essential between anesthesiology, obstetric, interventional radiology, gynecologic oncology, blood bank, and specialized surgical teams when taking care of a patient with placenta accreta.
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Curr Opin Anaesthesiol · Jun 2011
ReviewMaternal haemodynamic changes during spinal anaesthesia for caesarean section.
Maternal haemodynamic changes during spinal anaesthesia for caesarean section have traditionally been evaluated by noninvasive blood pressure and heart rate. Recent publications have addressed the importance of cardiac output measurement in the assessment of the maternal circulation. In this review, a physiological approach is suggested for the prevention and treatment of haemodynamic instability during caesarean section in healthy women and in those with preeclampsia or cardiac disease. ⋯ The most frequent response to spinal anaesthesia for elective caesarean section is a marked decrease in systemic vascular resistance and partial compensation from increased stroke volume and heart rate. Early administration of phenylephrine by bolus or continuous infusion is indicated in most cases. Recent work has expanded our knowledge of the therapeutic range of phenylephrine and indicates that the heart rate response to vasopressors is a good surrogate marker for cardiac output. Further research should examine haemodynamic changes during spinal anaesthesia in high-risk pregnant women with early onset preeclampsia or cardiac disease.
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To describe the recent advances in labor epidural analgesia, which may have an impact on maternal ambulation during labor. ⋯ Since the earliest 'walking epidural' was described in the early 1990s, there has been much research into finding the ideal regional technique for labor analgesia that provides excellent analgesia with high maternal satisfaction scores while having little adverse effect on obstetric outcome. This review attempts to map the journey of the 'walking epidural' from its earliest form to its more recognizable modern day appearance.
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To highlight recent developments in the field of perioperative nutritional support by reviewing clinically pertinent English language articles from October 2008 to December 2010, that examined the effects of malnutrition on surgical outcomes, optimizing metabolic function and nutritional status preoperatively and postoperatively. ⋯ An evidence-based multimodal pathway that includes interventions to optimize nutritional status may improve outcomes following elective surgery.
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This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. ⋯ The concept of preventive analgesia is still an attractive working hypothesis but with inconclusive results. A plea for better design of clinical studies is forwarded.