Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review
Review of the enhanced recovery pathway for children: perioperative anesthetic considerations.
Enhanced recovery after surgery (ERAS) pathways have been used for two decades to improve perioperative recovery in adults. Nevertheless, little is known about their effectiveness in children. The purpose of this review was to consider pediatric ERAS pathways, review the literature concerned with their potential benefit, and compare them with adult ERAS pathways. ⋯ Although adult ERAS pathways have been successful at reducing patient morbidity, the translation, creation, and utility of instituting pediatric ERAS pathways have yet to be realized.
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The use of transesophageal echocardiography (TEE) has evolved to include patients undergoing high-risk non-cardiac procedures and patients with significant cardiac disease undergoing non-cardiac surgery. Implementation of basic TEE education in training programs has increased across a broad spectrum of procedures in the perioperative arena. This paper describes the use of perioperative TEE in non-cardiac surgery and provides an overview of the basic TEE examination. ⋯ Perioperative TEE is emerging as a preferred tool to manage hemodynamics in high-risk procedures and in high-risk patients undergoing non-cardiac surgery. A rescue TEE examination protocol is a helpful approach for early identification of the etiology of hemodynamic instability.
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Lung ultrasound (LUS) has emerged as an effective and accurate goal-directed diagnostic tool that can be applied in real time for the bedside assessment of patients with respiratory symptoms and signs. Lung ultrasound has definite and easily recognized findings and has been shown to outperform physical examination and chest radiography for the diagnosis and monitoring of many pulmonary and pleural conditions. In this article, we review the principles of LUS image acquisition and interpretation, summarizing key terms and sonographic findings. ⋯ Because of the unique physical properties of the lungs, only a careful and systematic analysis of both artifacts and anatomical images allows accurate interpretation of sonographic findings. Future studies exploring the use of software for automatic interpretation, quantitative methods for the assessment of interstitial syndrome, and continuous monitoring devices may further simplify and expand the use of this technique at the bedside in acute medicine and the perioperative setting.
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Airway management is a critical skill in the practice of several medical specialities including anesthesia, emergency medicine, and critical care. Over the years mounting evidence has showed an increasing role of ultrasound (US) in airway management. The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. ⋯ A rapidly growing body of evidence showing ultrasonography used in conjunction with hands-on management of the airway may benefit patient care. Increasing awareness and use of POCUS for many indications have resulted in technologic advancements and increased accessibility and portability. Upper airway POCUS has the potential to become the first-line non-invasive adjunct assessment tool in airway management.
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Transthoracic examination of the heart and great vessels is an essential skill that allows the anesthesiologist to evaluate cardiac function. In this article, we describe a pragmatic technique to obtain the essential views to evaluate normal or abnormal cardiac function and to appreciate great vessel anatomy and physiology. ⋯ The integration of the echocardiographic information particularly from the heart and great vessels with the case story, physical examination, laboratory data, and other relevant clinical information should become the way of the future, and this will benefit the patients under our care.