Best practice & research. Clinical anaesthesiology
-
During the last 20 years, studies using continuous perioperative electrocardiogram (ECG) monitoring in patients at high risk for postoperative cardiac complications have revolutionized our understanding of the pathophysiology, circumstances, timing and possible prevention of perioperative ischemia and postoperative cardiac morbidity and mortality. The present review attempts to provide a comprehensive and practical summary of the current knowledge on perioperative myocardial ischemia. It starts with a description of the conventional definition of myocardial ischemia on exercise stress-testing and continues with a summary of the findings and insights collected from ambulatory Holter monitoring in non-surgical patients with coronary artery disease. It then recaps the variety of studies using perioperative ischemia monitoring to detail the concepts and controversies brought about by this type of monitoring, and tries to portray a general picture of the association of perioperative ischemia and postoperative cardiac complications-including myocardial infarction-and emphasize the importance of postoperative, not just intraoperative, ischemia monitoring.
-
The use of epidural analgesia for labor continues to increase dramatically. It has been suggested that epidural analgesia increases the risk of cesarean section, operative vaginal delivery, and prolonged labor. ⋯ It may affect the incidence of forceps delivery, but it depends on the medications used. Epidural analgesia does prolong labor, although the clinical significance of this prolongation has not been shown.
-
Best Pract Res Clin Anaesthesiol · Mar 2005
ReviewThe pediatric patient and upper respiratory infections.
Children frequently present for elective surgery in the setting of an active or recent upper respiratory infection. Respiratory adverse events are increased in this setting, but the threshold for cancelling a case varies widely between clinicians. ⋯ More data are needed on the risks of proceeding with surgery in the presence of these factors and on the impact of potential therapies to decrease the incidence of adverse events. Lidocaine and other therapies that reduce laryngospasm in well patients need to be evaluated in children with upper respiratory infection.
-
Best Pract Res Clin Anaesthesiol · Mar 2005
ReviewIs there an evidence-based approach to anesthesia education?
Education in anesthesiology offers a variety of unique forums. Examples include focused teaching in the operating room, bedside teaching in critical care settings, and simulations. Many approaches are used by educators with a wide range of effectiveness. ⋯ Developing effective teachers maintains quality in training, promotes interest and enthusiasm for academia, and provides role models for learners. Evidence-based approaches to education are increasing in anesthesiology. This chapter will discuss skills, techniques, and evaluative tools from the literature that illustrate evidence-based effectiveness and applications to anesthesiology.
-
Best Pract Res Clin Anaesthesiol · Mar 2005
ReviewNon-steroidal anti-inflammatory drugs, antiplatelet medications and spinal axis anesthesia.
Many individuals use cyclo-oxygenase inhibitors (COX-1 and COX-2 non-steroidal anti-inflammatory drugs) and antiplatelet medications on a regular basis. This is particularly true of the elderly, who are more prone to having osteoarthritis, rheumatoid arthritis, and cardiac disease. Some of these agents alter platelet function and may increase the risk of spinal/epidural hematoma formation if spinal axis anesthesia is utilized without following proper precautions. ⋯ Anesthesiol. Reanim. 48 (2001) 270]. This article explains the mechanism of action of each of the medications which alter platelet function, defines the risks of hematoma formation should the medication be inadvertently continued into the perioperative period, and provides guidelines and recommendations on how to manage each class of drug prior to the placement of spinal/epidural blocks.