British journal of anaesthesia
-
Patient blood management (PBM) encompasses implementing multimodal evidence-based strategies to screen, diagnose, and properly treat anaemia and coagulopathies using goal-directed therapy while minimising bleeding. The aim of PBM is to improve clinical care and patient outcomes while managing patients with potential or ongoing critical anaemia, clinically significant bleeding, and coagulopathies. The focus of PBM is patient-centred rather than transfusion-centred. ⋯ Neonates, infants, children, and adolescents each have specific considerations based on age, weight, physiology, and pharmacology. This narrative review covers the latest updates for PBM in paediatric surgical populations including the benefits and principles of paediatric PBM, current expert consensus guidelines, and important universal multimodal therapeutic strategies emphasising clinical management of the anaemic, bleeding, or coagulopathic paediatric patient in the perioperative period. Practical paediatric rules for PBM in the perioperative period are highlighted, with review of specific PBM strategies including treatment of preoperative anaemia, restrictive transfusion thresholds, antifibrinolytic agents, cell salvage, standardised transfusion algorithms, and goal-directed therapy based on point-of-care and viscoelastic testing.
-
Postoperative anxiety and depression can negatively affect surgical outcomes and patient wellbeing. This study aimed to quantify the incidence of postoperative worsening anxiety and depression symptoms and to identify preoperative predictors of these conditions. ⋯ Postoperative worsening anxiety and depression appear to be associated more closely with preoperative active mental health or pain symptoms rather than self-reported history of these conditions. Preoperative identification of at-risk patients will require screening for symptoms rather than simple history taking.
-
Flexible bronchoscopy for tracheal intubation is indicated in patients with difficult airways, but the upper airway is frequently obstructed in sedated or anaesthetised apnoeic patients. This makes it more difficult to locate the glottis through bronchoscopy, and increases the risk of hypoxaemia. Nasal high-flow oxygenation is useful to prevent hypoxaemia during airway management, but no studies have assessed if this method of oxygenation improves the bronchoscopic view of the glottis by preventing upper airway obstruction. ⋯ Nasal high-flow oxygenation facilitates flexible bronchoscopy for tracheal intubation by widening the pharyngeal space and by improving the view of the glottis through the bronchoscope. Therefore, use of nasal high-flow oxygenation is useful in patients with difficult airways in whom flexible bronchoscopy for tracheal intubation is indicated.
-
Delayed gastric emptying increases the risk of pulmonary aspiration during anaesthesia for Caesarean delivery. Our aim in conducting this narrative review was to consider the effect of pregnancy on gastric emptying. The indices of gastric emptying after liquids, solids, or both and when fasted in the various trimesters of pregnancy, at the time of Caesarean delivery, in labour, and the postpartum period were assessed. ⋯ Women in labour who have eaten solids in the last 8 h still have high-risk gastric contents present in the stomach. The evidence with respect to the postpartum period is conflicting. In conclusion, inconsistencies in the literature reflect the unpredictability of gastric emptying in pregnancy and underline the potential value of gastric ultrasound in women who are pregnant.