Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewContinuous peripheral nerve blockade for postoperative analgesia.
To review the recent literature involving the use of continuous peripheral nerve sheath catheters in the management of postoperative pain. ⋯ Continuous peripheral nerve blocks are an excellent additional modality to compliment other multimodal analgesics to control moderate to severe postoperative pain.
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To outline recent developments emphasizing the current literature on ophthalmic regional anaesthesia including modern sharp needle and blunt cannula sub-Tenon's blocks. ⋯ At present, there is no absolutely safe ophthalmic regional block. It is imperative therefore to have a basic knowledge of anatomy and technique which reduce complications.
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Curr Opin Anaesthesiol · Oct 2008
ReviewIncreased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery.
Literature since 2006 was reviewed to identify the harms and costs of red blood cell (RBC) transfusion. ⋯ The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services. This evidence should shift clinicians' equipoise towards more restrictive transfusion practice. The immediate aim should be to avoid transfusing small numbers of RBC units for general malaise attributed to anaemia, a practice which appears to occur in about 50% of transfused patients. Randomized trials comparing restrictive and liberal transfusion triggers are urgently needed to compare directly the balance of benefits and harms from RBC transfusion.
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Curr Opin Anaesthesiol · Oct 2008
ReviewTranscranial Doppler ultrasonography: a diagnostic tool of increasing utility.
Since its introduction in 1982, transcranial Doppler ultrasonography has become an important diagnostic and monitoring tool in patients with surgical disease. It has applications in the perioperative period, as well as in the intensive care unit. It is therefore appropriate for the anesthesiologist to maintain an understanding of its current utility. ⋯ Although there are several settings in which transcranial Doppler has well established usefulness, there are many more in which it is likely valuable, such as traumatic brain injury, ischemic stroke, and fulminant hepatic failure. Further research is needed in these fields to elucidate the exact role for transcranial Doppler.
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The demand of procedures performed on children outside the operating room setting often exceeds the capacity of anesthesia services. The number of children requiring sedation outside the traditional operating room is rapidly approaching the number of children requiring anesthesia in the operating room. We address some of the major issues and controversies in this continuously evolving field. ⋯ A standard approach (adequate preparation, clinical assessment of the child, fasting as required and right sedation plan) is mandatory to provide safety and efficiency. Sedation is a continuum, and it can be easy to advance from one level to the next and even reach a state of general anesthesia. Newer modalities such as end-tidal CO2 and, maybe, bispectral index monitoring are indeed enhancing the safety of procedural sedation and analgesia.