Journal of anesthesia
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Journal of anesthesia · Oct 2024
Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.
While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates. ⋯ Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.
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Journal of anesthesia · Oct 2024
ReviewRemimazolam for anesthesia and sedation in pediatric patients: a scoping review.
Anesthetic management of pediatric patients poses several challenges and the optimal anesthetic agent for use in this population is still a matter of debate. We systematically searched PubMed/MEDLINE and Google Scholar from their inception for studies that investigated the role and potential applications of remimazolam, a novel ultra-short-acting benzodiazepine, in pediatric patients. Furthermore, in March 2024, an update of the literature search along with an additional post-hoc search on the EMBASE database were performed. ⋯ Moreover, the current evidence suggested that remimazolam may contribute to reducing preoperative anxiety and postoperative delirium in children. Its favorable pharmacodynamic and pharmacokinetic profile demonstrated potential safety, effectiveness, and ease-of-use in various perioperative pediatric contexts, making it suitable for integration into specific protocols, such as intraoperative monitoring of evoked potentials and management of difficult intubation. Notwithstanding these promising findings, further research is essential to determine optimal dosages, establish conclusive evidence of its superiority over other benzodiazepines, and elucidate the impact of genetic factors on drug metabolism.
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Oliguria is a clinical symptom characterized by decreased urine output, which can occur at any stage of acute kidney injury and also during renal replacement therapy. In some cases, oliguria may resolve with adjustment of blood purification dose or fluid management, while in others, it may suggest a need for further evaluation and intervention. ⋯ The above conditions all implying a renal oxygen supply-demand imbalance, which is the signal of worsening kidney injury. It also proposes a viable clinical pathway for the treatment and management of patients with acute kidney injury receiving renal replacement therapy.