Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2008
ReviewNeurological complications following central neuraxial blockades in obstetrics.
The last few decades have seen an increased use of central neuraxial blockades in obstetric patients. Central blockades provide excellent labour analgesia and safe anaesthesia for caesarean section associated with low incidence of severe complications. Therefore, an increasing number of blockades are also performed in women affected by significant disease. The risks and benefits of central blockades, however, might differ in these patients. This review addresses the risks of neurological complications following central neuraxial blockades in healthy parturients as well as in women affected by significant haemostatic and neurological disease. ⋯ Estimation of the incidence of neurological complications following central neuraxial blockades to women affected by significant disease on the basis of case reports and small series of patients is impossible. Prospective registration of high-risk patients may increase our knowledge. Application of central neuraxial blockade must follow individual evaluation.
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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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Curr Opin Anaesthesiol · Jun 2008
ReviewMaintaining labour epidural analgesia: what is the best option?
The intensity of labour pain is influenced by a multitude of factors. In this article, we discuss recent advances in the administration of labour epidural analgesia which have been targeted at creating a more satisfactory birthing experience for the parturient while safeguarding maternal and fetal well being. ⋯ Recent advances in medical technology have equipped us with many novel drug delivery modalities, which will enable us to customize a suitable analgesic regimen for each parturient.
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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.
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Curr Opin Anaesthesiol · Jun 2008
ReviewInfection associated with central venous or epidural catheters: how to reduce it?
Central venous catheters are a leading source of nosocomial bloodstream infection with an estimated 10% mortality. Infection associated with epidural catheterization is an uncommon but devastating complication. Diagnosis of spinal epidural abscess requires a high index of suspicion and imaging techniques such as MRI. Early diagnosis and treatment will minimize permanent damage, but primary prevention should be the aim, which depends on proper patient evaluation and use of full aseptic precautions. ⋯ Healthcare worker education and training are essential to create standardization of aseptic care. Continuous surveillance is necessary for identifying lapses in infection-control practices.