International anesthesiology clinics
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Int Anesthesiol Clin · Jan 1994
ReviewBlood, fluids, and electrolytes in the pediatric trauma patient.
Successful resuscitation of pediatric trauma patients begins with identification of the physiological abnormalities that require intervention. Health care practitioners in the prehospital, emergency room, and operating room settings must be familiar with normal physiological parameters to be able to recognize abnormalities and begin resuscitative efforts. Recognition of shock may be more subtle in the pediatric patient, because blood pressure can be maintained in the face of a marked decrease in circulating blood volume. ⋯ The area of fluid management and blood transfusion has undergone extensive change in the last decade but needs continued investigation in the pediatric trauma population. Studies targeting this population are limited, and current practices are based largely on extrapolation from adult experience and studies. The area continues to evolve, but further research is needed to improve resuscitation in the pediatric trauma patient.
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Regional anesthesia has several distinct advantages over general anesthesia in the patient scheduled for ambulatory surgery. These include residual analgesia and a lower incidence of postoperative nausea and vomiting. With appropriate choice of regional technique and local anesthetic drug, earlier ambulation and discharge are often possible. ⋯ Regional anesthesia requires more time to administer than does general anesthesia, and ideally should be performed in an induction area. However, use of such an area, or employment of techniques with a rapid onset of analgesia (e.g., intravenous regional of spinal anesthesia) may actually reduce the total amount of time a patient spends in the ambulatory unit [16]. Selected application of regional techniques will help convince surgeons, anesthesiologists, and nurses of the advantages of regional blockade and may ultimately lead to greater patient and surgeon satisfaction.
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General anesthesia is the most common form of anesthetic management for ambulatory surgery. Patients, in general, prefer general anesthesia because it is less anxiety provoking. During the last decade, the availability of several short-acting agents with high clearance has made general anesthetic techniques much safer and more predictable for outpatients. ⋯ The introduction of several new agents (e.g., propofol, desflurane, vecuronium, atracurium, mivacurium, rocuronium, alfentanil, ondansetron, ketorolac) has made ambulatory general anesthesia less challenging and more interesting. In the future, the new anesthetic sevoflurane, and the new opioid remifentanil, may prove useful for ambulatory anesthesia. The LMA has all but revolutionized airway management during general anesthesia for ambulatory surgery.