Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2009
ReviewSpontaneous respiration during intravenous anesthesia in children.
Maintaining spontaneous respiration during intravenous anesthesia for investigative and surgical procedures may avoid the need for airway instrumentation and reduce the risk of desaturation. In addition, when performing airway endoscopic procedures in children, maintaining spontaneous respiration while using intravenous anesthesia can reduce the need for endotracheal intubation. This facilitates improved access to the smaller airway, allows assessment of the dynamic function of the airway, and reduces exposure of personnel to inhaled anesthetic agents. ⋯ Spontaneous respiration can be maintained when anesthetizing children using intravenous anesthesia.
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To evaluate the effect of epidural analgesia on breastfeeding. ⋯ There is no good evidence that epidural analgesia causes reduced breastfeeding success. Good lactation support is critical.
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Obesity is a growing healthcare problem worldwide, which also affects the pregnant population. Obesity occurs with increasing frequency during pregnancy. Obesity increases the maternal, fetal and neonatal risks. Also, the anesthesiologist is confronted with significantly more problems when the parturient is overweight or obese. The present review focuses on the anesthetic implications of obesity in pregnancy. ⋯ Anesthesia-related complications are more frequent in obese parturients. Most authors and opinion leaders agree that regional anesthesia is the preferred technique for Cesarean section in obese patients, and that efforts to place early labor epidural analgesia should be optimized in order to be able to avoid general anesthesia when unplanned Cesarean section is required.
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Curr Opin Anaesthesiol · Jun 2009
ReviewTattooing and various piercing: anaesthetic considerations.
Body art is increasing since the 1990s. Anaesthesiologists would be more and more confronted to patient with tattooing or piercing, or both. This review discusses the anaesthetic potential risks and complications observed with tattooing and piercing, their management and prevention. ⋯ Oral and nasal piercing is of particular concern because of the risks of swallowing and aspiration. Consequently, patients should be advised to remove piercing before anaesthesia. Emergency situations are especially risky and anaesthesiologists should be aware of the piercing removal techniques. In case of piercing loss, radiographies and fiberoptic endoscopy of the upper airways and digestive tracts should be performed to eliminate aspiration or swallowing of the foreign body. Epidurals should not be denied to parturients with lumbar tattooing. However, it seems still prudent to avoid direct tattoo puncture or when unavoidable, to nick the skin prior to inserting the needle through the tattoo.
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Curr Opin Anaesthesiol · Apr 2009
ReviewMicrocirculation and mitochondria in sepsis: getting out of breath.
To present the recent findings obtained in clinical and experimental studies examining microcirculatory alterations in sepsis, their link to mitochondrial dysfunction, and current knowledge regarding the impact of these alterations on the outcome of septic patients. ⋯ Even though there is evidence that microcirculatory and mitochondrial dysfunction plays a role in the development of sepsis-induced organ failure, their interaction and respective contribution to the disease remains poorly understood. Future research is necessary to better define such relationships in order to identify therapeutic targets and refine treatment strategies.