Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2000
Patient-controlled epidural analgesia or continuous infusion: advantages and disadvantages of different modes of delivering epidural analgesia for labour.
Patient-controlled epidural analgesia, intermittent top-up and continuous infusion are equally effective in providing epidural pain relief during labour. Patient-controlled epidural analgesia is associated with a significant reduction in hourly dose requirements when compared with continuous infusion, and by transferring the responsibility for epidural top-up, it offers the parturient the psychological benefit of being in control. ⋯ However, the safety of the method needs to be documented more extensively, and the advantage of a reduction in hourly dose requirements needs to be visualized in terms of an improvement in labour or neonatal outcome. Moreover, the optimal dose, drug combination and settings still remain to be determined.
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Over the years, ketamine has found many applications in paediatric anaesthesiology. Recent insights into the mechanism of its central action, and the pharmacology of its isomers have led to a re-evaluation of this drug, expanding the range of indications in adults. The best examples of the uses of ketamine as an analgesic are: in brief diagnostic or therapeutic procedures, during the post-operative period in neonates and infants as well as in paediatric anaesthesia and intensive care.
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Curr Opin Anaesthesiol · Apr 2000
Severity scoring systems and the prediction of outcome from intensive care.
Severity scoring systems are tools that provide a predicted mortality for a group of intensive care unit patients on the basis of derangement of their physiology and some past medical history. This predicted mortality can then be compared with the actual mortality to give some indicator of the effectiveness of the package of care delivered by the intensive care unit, corrected for differences in case-mix. ⋯ This may be partly due to limitations in their ability to predict mortality outside the population on which they were developed, and to the change in calibration of the system with time and advances in medical science. This review briefly addresses the limitations of severity scoring systems in light of recent publications.
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Recent studies suggest that perioperative pulmonary aspiration is an infrequent event (approximately 1 : 2000-3000 general anesthetics), but its impact on individual patients can be devastating. Patients who appear to have the greatest risk of developing severe pulmonary morbidity or dying after aspiration are those who are sick (American Society of Anesthesiologists physical classification 3 or greater) and elderly. As a general rule, children have less morbidity from pulmonary aspiration.