Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 2018
Neuraxial Anesthesia During Cesarean Delivery for Placenta Previa With Suspected Morbidly Adherent Placenta: A Retrospective Analysis.
Cesarean section for morbidly adherent placenta can be successfully managed with neuraxial anesthesia, although with a modest conversion rate to general anesthesia.
pearl -
Anesthesia and analgesia · Oct 2018
Randomized Controlled TrialPreoperative Continuation Versus Interruption of Oral Hypoglycemics in Type 2 Diabetic Patients Undergoing Ambulatory Surgery: A Randomized Controlled Trial.
It’s likely safe to continue metformin and sulphonylureas in those fasting for day surgery, in the absence of renal impairment.
pearl -
Anesthesia and analgesia · Oct 2018
Meta AnalysisLaryngeal Mask Airway Versus Other Airway Devices for Anesthesia in Children With an Upper Respiratory Tract Infection: A Systematic Review and Meta-analysis of Respiratory Complications.
LMA use in children with URTIs reduces cough compared to intubation, but possibly not laryngospasm, although quality of evidence is poor.
pearl -
Anesthesia and analgesia · Oct 2018
ReviewPatient Blood Management in Pediatric Cardiac Surgery: A Review.
Efforts to reduce blood product transfusions and adopt blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red blood cell and coagulant blood products perioperatively for many reasons, including developmental alterations of their hemostatic system, and hemodilution and hypothermia with cardiopulmonary bypass that incites inflammation and coagulopathy and requires systemic anticoagulation. ⋯ This review summarizes the available evidence regarding anemia management and blood transfusion practices in the perioperative care of these critically ill children. The evidence suggests that adoption of a comprehensive blood management approach decreases blood transfusions, but the impact on clinical outcomes is less well studied and represents an area that deserves further investigation.
-
Anesthesia and analgesia · Oct 2018
Observational StudyBlood Pressure Coefficient of Variation and Its Association With Cardiac Surgical Outcomes.
Multiple studies completed in the ambulatory nonsurgical setting show a significant association between short- and long-term blood pressure variability and poor outcomes. However, perioperative blood pressure variability outcomes have not been well studied, especially in the cardiac surgical setting. In this study, we sought to assess whether systolic and mean arterial blood pressure variability were associated with 30-day mortality and in-hospital renal failure in patients undergoing cardiac surgery requiring cardiopulmonary bypass. Furthermore, blood pressure variability has not been evaluated specifically during each phase of surgery, namely in the pre-, intra- and postbypass phases; thus, we aimed also to assess whether outcomes were associated with phase-specific systolic and mean arterial blood pressure variability. ⋯ Increasing systolic blood pressure variability was associated with 30-day mortality and development of renal failure, with surgery phase-specific relationships observed. Further research is required to determine how to prospectively detect blood pressure variability and elucidate opportunities for intervention.