Anaesthesia
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Regional anaesthesia is a cornerstone in paediatric anaesthesia today. Many paediatric anaesthetists include regional anaesthetic techniques in their daily clinical practice to provide superior and long-lasting analgesia without the risk of respiratory depression. The first part this article reviews new scientific findings in the field of paediatric regional anaesthesia. The second part focuses on safety aspects and on the impact of ultrasound on paediatric regional anaesthesia.
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Multicenter Study
Category-1 caesarean section: a survey of anaesthetic and peri-operative management in the UK.
A national survey of anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. There was a 70% response rate. The median (IQR [range]) general anaesthetic rate was 51% (29%-80% [6%-100%]), 12% (9%-16% [3%-93%]), 4% (2%-5% [<1%-18%]), for category-1 caesarean section, categories 1-3 (non-elective/emergency) and category-4 (elective) caesarean section, respectively. ⋯ One hundred and thirty-nine (81%) use the standard urgency classification described in the NICE caesarean section guideline. However, only 72 (42%), 24 (14%), and 16 (9%) units comply with this guideline's recommended decision-delivery intervals for category-1 (< or = 30 min), category-2 (< or = 30 min) and category-3 (< or = 75 min) caesarean sections, respectively. Practice in the smaller units was similar to that in the larger units, although there was less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite in the smaller units.
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This article discusses recent innovations and changes in practice in upper limb regional anaesthesia, dividing the blocks into those performed above the clavicle, those performed in the area of the clavicle and those performed below it. It offers a critical appraisal of the current status with regard to the use of ultrasound nerve location for upper limb regional anaesthesia and, while accepting that the use of ultrasound in this way has many theoretical advantages and will therefore continue to grow, concludes that there is currently insufficient published evidence to determine conclusively that the use of this technique is associated with nerve blocks that are more successful or safer.
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Regional anaesthesia is undergoing a renaissance, perhaps assisted by the introduction of (and enthusiasm for) ultrasound-guided regional anaesthesia into clinical practice. This article summarises the technology and principles of ultrasound imaging in anaesthesia and describes the development of three-dimensional ultrasound imaging, considering whether this new technology has an application in regional anaesthesia.
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Despite recent advances in analgesia delivery techniques and the availability of new analgesic agents with favourable pharmacokinetic profiles, current evidence suggests that postoperative pain continues to be inadequately managed, with the proportion of patients reporting severe or extreme postoperative pain having changed little over the past decade. Regional techniques are superior to systemic opioid agents with regards to analgesia profile and adverse effects in the context of general, thoracic, gynaecological, orthopaedic and laparoscopic surgery. Outcome studies demonstrate that regional analgesic techniques also reduce multisystem co-morbidity and mortality following major surgery in high risk patients. This review will discuss the efficacy of regional anaesthetic techniques for acute postoperative analgesia, the impact of regional block techniques on physiological outcomes, and the implications of acute peri-operative regional anaesthesia on chronic (persistent) postoperative pain.