Current opinion in anaesthesiology
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To look at different anesthetic approaches to different surgical techniques used in fetal procedures and the influence of maternal and fetal factors on anesthetic management. ⋯ Open fetal surgery remains a major invasive procedure for mother and fetus both, requiring general anesthesia with adequate invasive monitoring. Minimal invasive fetal procedures can be performed with local anesthesia alone or, for the more complex fetoscopic procedures, with a neuraxial locoregional technique. Fetal anesthesia and analgesia can then be provided by different routes. Ex-utero intrapartum treatment procedures are open fetal procedures, but they can be performed with locoregional anesthesia, when uterine relaxation can be achieved without volatile anesthetics with the use of intravenous nitroglycerin.
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Clinical practices in oxygen administration are in need of change based on the increasing understanding of oxygen toxicity. Hypoxemia is due to many pathophysiological causes; avoiding hypoxemia is an important objective during neonatal anesthesia. Nevertheless, the only known cause for hyperoxemia is the excess and unnecessary administration of oxygen by healthcare providers. To avoid hyperoxemia is an important objective during neonatal anesthesia. ⋯ Even brief neonatal exposures to pure oxygen must be avoided during neonatal anesthesia. When any dose of supplemental oxygen is given, a reliable pulse oximeter aiming to avoid hyperoxemia is necessary. Even though further research is essential, administration of oxygen by healthcare providers when it is not necessary is a foe and a neonatal health hazard.
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Recently, many researchers have been studying stress and burnout in anaesthesia. Some researchers have examined the effects of stress in the workplace. Others have identified some job characteristics that have an impact on anaesthetist's well-being. Yet, few studies use the same measure of stress and/or define the concept of stress in the same way, making comparison and aggregation of results difficult, and therefore minimizing the general impact of these research findings. ⋯ From the referred studies, the review challenges the more practical problems of prevention of stress and burnout and provides some avenues for future investigations.
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Haemorrhage remains a cause of significant maternal morbidity and mortality. This review summarizes the prevention, management and treatment of obstetric haemorrhage and highlights recent advances and developments. ⋯ Accurate diagnosis and appropriate management of obstetric haemorrhage can reduce maternal morbidity and mortality. This review outlines the current evidence.