Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2008
ReviewLow-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension.
The present review evaluates the evidence available in the literature to see whether low-dose spinal anaesthesia for Caesarean section is effective in preventing maternal hypotension while at the same time guaranteeing effective anaesthetic conditions. ⋯ Low-dose spinal anaesthesia as part of a combined spinal-epidural technique is a valuable method in improving maternal and fetal outcome during anaesthesia for operative delivery.
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Curr Opin Anaesthesiol · Jun 2008
ReviewManagement of postdural puncture headache in the obstetric patient.
The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007. ⋯ The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.
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To knock down the following myths: obesity in paediatric patients is rare and mainly a North-American problem; obesity in childhood has no long-term harmful effects. To sensitize the anaesthesiologists to a problem seldom addressed in the anaesthetic literature. ⋯ The early manifestations of the comorbidities associated with obesity in adults are already present in overweight and obese children and should be addressed for their safe anaesthetic management. Perioperative respiratory events seem more frequent in overweight and obese patients.
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Nitrous oxide has been used in clinical practice for over 150 years, often for pediatric procedures. Not only are there problems when used in patients with a variety of inborn errors of metabolism, but effects of nitrous oxide on the developing human brain are unknown. ⋯ There is a growing body of evidence that supports avoidance of nitrous oxide in both pediatric and adult patients, but the thousands of patients who have been exposed to nitrous oxide without apparent complications would suggest that further studies on long-term side effects and possible neurologic consequences need to be done.
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The present review describes new trends and ongoing controversies in the anesthetic care of liver transplant recipients. ⋯ Anesthetic management still varies widely between liver transplant centers with little data to indicate best practice. Future research should focus on fluid replacement, prevention and treatment of coagulopathy, care of the acutely ill patient and the safety and benefits of early extubation.