Current opinion in anaesthesiology
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Paravertebral blocks are becoming increasingly popular, especially as an anesthetic adjunct for breast procedures. New reports suggest additional reasons for adding this block to the anesthetic armamentarium. ⋯ Paravertebral blocks are a well established option to provide anesthesia and postoperative analgesia during breast surgery. Recent studies suggest additional benefits to this procedure. Not only is acute pain better controlled, but the development of chronic mastectomy pain syndrome and recurrence of cancer may be reduced by preoperative placement of paravertebral block. These studies provide additional reasons why this block should be considered as part of the anesthetic for breast surgery.
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Curr Opin Anaesthesiol · Aug 2007
ReviewNon-anesthesiologist-provided pediatric procedural sedation: an update.
This review evaluates the past year's literature on the provision of pediatric procedural sedation outside of the operating room, especially as performed by non-anesthesiologist healthcare providers. ⋯ Pediatric procedural sedation practice as performed by non-anesthesiologists continues to grow. Ongoing efforts to understand the elements of sedation systems that lead to best practice, with the subsequent development of uniform practice approaches, are essential. A collaborative relationship between anesthesiologists and non-anesthesiologist providers of procedural sedation is essential for meeting common goals.
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Curr Opin Anaesthesiol · Aug 2007
ReviewAnesthesia practice in the emergency department: overview, with a focus on airway management.
To review the need for interdisciplinary collaboration to reduce human and system-related errors in the emergency care setting. ⋯ The implications of collaboration are sweeping; not only for optimizing patient care but leading to a 'win-win' situation for medical personnel by improving relationships to better address global needs and optimize the opportunities for collaboration, which is particularly true for urgent/emergent airway management.
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Curr Opin Anaesthesiol · Aug 2007
ReviewBlood substitutes as pharmacotherapies in clinical practice.
To discuss the development and current status of blood substitutes, including hemoglobin-based oxygen carriers (HBOCs) and perfluorocarbons. Research in this field offers an important view into the future of transfusion medicine in the operating room, as well as in trauma and combat arenas. ⋯ Polymerized hemoglobin preparations have proven most successful in clinical trials due to their improved side-effect profile. The goal is to evaluate blood substitutes with enhanced intravascular retention, reduced osmotic activity, and attenuated hemodynamic derangements such as vasoconstriction. Although not without substantial morbidity and mortality, the current safety of allogeneic blood transfusion demands that comparative studies show minimal adverse effects, as well as efficacy and potential for novel applications.