Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2009
ReviewEffect of head posture on pediatric oropharyngeal structures: implications for airway management in infants and children.
Although head and neck posture has direct effects on the upper airway in infants and children, many of these effects remain unclear or not well established. As airway patency and airway access are critical in sedated and/or unconscious children, recent developments in this area should be made known to pediatric anesthesiologists, intensive care physicians and other emergency caregivers. ⋯ The site of obstruction of the airway in sedated children in different postures is now more clear. Implications of head flexion and extension in intubated children have been extensively studied, and clinical consequences have been detailed. Due to large interindividual anatomic variability, depth marks set on the tubes by their manufacturers and guidelines regarding calculations of insertion depth should be made with caution in infants and neonates. Despite several studies, there is still little scientific evidence regarding proper head posture for laryngoscopy and intubation.
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Curr Opin Anaesthesiol · Jun 2009
ReviewChanging trends in paediatric regional anaesthetic practice in recent years.
Regional anaesthesia has come to a substantial position in paediatric anaesthesia. Time has now come to assess what has reached significant acceptance in daily practice and try to clear possible ways up for the next steps to come. ⋯ Lessons can be drawn from epidemiologic data now available and possible ways for changes in a near future can be anticipated. Ultrasonology brings clear advantages in abdominal wall blocks. Its use in place of nerve stimulation is claimed forcefully but not yet widely used for the blocks of the limbs in children. This switch requires profound changes in the practice of regional anaesthesia which will probably not take place immediately. Blocks of the face appear innovating and promising, according to recent literature.
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Curr Opin Anaesthesiol · Jun 2009
ReviewCommunication between anaesthesiologists and patients: how are we doing it now and how can we improve?
The purpose of this review is to present and bring together the relatively small body of recent work on anaesthesiologist-patient communication. ⋯ Communication between anaesthesiologists and patients is essential for effective clinical practice. Some practical suggestions are made and pointers to further reading given.
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Curr Opin Anaesthesiol · Jun 2009
ReviewTattooing and various piercing: anaesthetic considerations.
Body art is increasing since the 1990s. Anaesthesiologists would be more and more confronted to patient with tattooing or piercing, or both. This review discusses the anaesthetic potential risks and complications observed with tattooing and piercing, their management and prevention. ⋯ Oral and nasal piercing is of particular concern because of the risks of swallowing and aspiration. Consequently, patients should be advised to remove piercing before anaesthesia. Emergency situations are especially risky and anaesthesiologists should be aware of the piercing removal techniques. In case of piercing loss, radiographies and fiberoptic endoscopy of the upper airways and digestive tracts should be performed to eliminate aspiration or swallowing of the foreign body. Epidurals should not be denied to parturients with lumbar tattooing. However, it seems still prudent to avoid direct tattoo puncture or when unavoidable, to nick the skin prior to inserting the needle through the tattoo.
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Curr Opin Anaesthesiol · Jun 2009
ReviewAnaesthetic issues in women undergoing gynaecological cytoreductive surgery.
Increasing numbers of women with ovarian cancer are undergoing cytoreductive surgery in reference centres. This review looks at this disease in these women and the different aspects of perioperative clinical management of these patients by the anaesthetic team: preoperative screening, anaesthetic techniques, fluid or blood management or both and prevention and treatment of important complications. ⋯ Anaesthesia is more than 'keeping asleep'. Anaesthesiologists have an enormous responsibility in the preoperative, peroperative, and postoperative period for patients undergoing gynaecological cytoreductive surgery.