Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2021
ReviewA decade later, there are still major issues to be addressed in paediatric anaesthesia.
Despite real advances in paediatric anaesthesia management, such as a growing awareness of the relevance of anaesthesia conduct as well as of the lack of evidence for neurotoxicity of anaesthetic agents, it must be said that there are still important questions in our specialty that remain unanswered. Standardization and harmonization of airway management, analgesia techniques and outcome measures are the important issues we are facing at the beginning of this decade. ⋯ The shift in research from the neurotoxicity of anaesthetic agents to factors related to anaesthetic conduct are discussed. Examples for an improvement in anaesthesia management are highlighted with advocacy for including these evidence-based findings in routine clinical practice. Finally, the impact of using clinically relevant age-related and patient-centred perioperative outcomes is essential for comparing and/or interpreting the safety and efficacy of anaesthesia and analgesia management in children.
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Curr Opin Anaesthesiol · Jun 2021
ReviewPatients with psychiatric disease: implications for anesthesiologists.
Psychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities. ⋯ From our review of the recent literature we continue to support the continuation of psychoactive agents in the perioperative period, taking into consideration the effects these agents have on concomitant drug use in the perioperative period; and the risks of withholding them at a high-stress time.
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Curr Opin Anaesthesiol · Jun 2021
Review Practice GuidelineManagement of maternal COVID-19: considerations for anesthesiologists.
To describe updates to pragmatic recommendations that were published during the first coronavirus disease 2019 (COVID-19) surge, including the current thinking about whether pregnancy worsens the severity of COVID-19. ⋯ Initial recommendations to provide early neuraxial labor analgesia and avoid general anesthesia for cesarean delivery have not changed over time. Although workflows have significantly changed to allow continued patient and healthcare workers' safety, clinical anesthesia protocols for labor and delivery are essentially the same.
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Pregnancy exacerbates sickle cell disease (SCD) and is associated with increased frequency and severity of complications resulting in high levels of maternal and fetal morbidity and mortality. We review recent recommendations for managing SCD in pregnancy. ⋯ Patients should be managed by a multidisciplinary and experienced team. The perioperative episode is a recognized period of disease exacerbation and informed anesthetic management can contribute to improved patient outcomes.
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Childhood obesity is a public health emergency that has reached a pandemic level and imposed a massive economic burden on healthcare systems. Our objective was to provide an update on (1) challenges of obesity definition and classification in the perioperative setting, (2) challenges of perioperative patient positioning and vascular access, (3) perioperative implications of childhood obesity, (3) anesthetic medication dosing and opioid-sparing techniques in obese children, and (4) research gaps in perioperative childhood obesity research including a call to action. ⋯ Anesthesiologists and surgeons will continue to be confronted with an unprecedented number of obese or overweight children with a high risk of perioperative complications.