Current opinion in anaesthesiology
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Patients with pulmonary hypertension who undergo anesthesia and surgery have high morbidity and mortality. Recent advances in our understanding of pulmonary hypertension and its therapy provide an opportunity to improve outcomes. ⋯ The cause of pulmonary hypertension should be defined in perioperative patients with pulmonary hypertension, and therapy should be optimized prior to anesthesia. Pulmonary artery catheterization may be required to confirm the presence of pulmonary hypertension and its severity. The focus of anesthetic management is to maintain right ventricular cardiac output and avoid systemic hypotension. Inhaled vasodilators such as nitric oxide and prostacyclin can be life-saving when perioperative right heart failure occurs due to exacerbation of pulmonary hypertension.
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Curr Opin Anaesthesiol · Jun 2010
ReviewNear infrared spectroscopy in children at high risk of low perfusion.
Tissue oximetry has been suggested as a noninvasive tool to continuously monitor and detect states of low body perfusion. This review summarizes recent developments and available data on the use of near infrared spectroscopy (NIRS) in children at risk for low perfusion. ⋯ Despite shortcomings in the ability of NIRS technology to accurately reflect validated and directly measured parameters of systemic oxygen delivery and blood flow, NIRS can certainly assist in the detection of low-flow states (low cardiac output). Large, randomized, prospective studies with well defined outcome parameters are still missing and warranted in order to clearly define the role of NIRS in children at risk for low perfusion.
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There is an emerging epidemic of obesity worldwide resulting in a greater number of obese patients presenting for surgery. The combined problems of metabolic disease and mechanical impairment from excess tissues present a variety of problems for the anesthesiologist. ⋯ Current studies have focused on the immediate impact of obesity on anesthesia and postoperative care. Future research will focus primarily on perioperative metabolic optimization.
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Curr Opin Anaesthesiol · Jun 2010
ReviewAnesthesia for patients with a history of malignant hyperthermia.
Malignant hyperthermia-susceptible patients have an increased risk during anaesthesia. The aim of this review is to present current knowledge about pathophysiology and triggers of malignant hyperthermia as well as concepts for safe anaesthesiological management of these patients. ⋯ The incidence of malignant hyperthermia is low, but the prevalence can be estimated as up to 1: 3000. Because malignant hyperthermia is potentially lethal, it is relevant to establish management concepts for perioperative care in susceptible patients. This includes preoperative genetic and in-vitro contracture testing, preparation of the anaesthetic workstation, use of nontriggering anaesthetics, adequate monitoring, availability of sufficient quantities of dantrolene and appropriate postoperative care. Taking these items into account, anaesthesia can be safely performed in susceptible patients.
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Curr Opin Anaesthesiol · Jun 2010
ReviewIs ultrasound guidance mandatory when performing paediatric regional anaesthesia?
Since Kapral in 1994 first described the use of real-time ultrasound-guided regional anaesthesia, this novel technique has gained widespread recognition in adult practice and has been shown to be associated with clinically relevant advantages. The aim of this manuscript is to review the currently published paediatric data associated with the use of ultrasound-guided regional anaesthesia. ⋯ Based on current data the use of ultrasound guidance is strongly recommended when performing peripheral nerve blocks in infants and children. Concerning ultrasound assistance in relation to paediatric neuroaxial blocks there is currently not enough supporting evidence to issue a general recommendation regarding its routine use.