Current opinion in anaesthesiology
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The purpose of this review is to discuss the risk factors associated with laryngospasm and the techniques used for prevention and treatment. We also summarize the prevention and treatment modalities in organized algorithms. ⋯ Identifying the risk factors and taking the necessary precautions are the key points in prevention of laryngospasm. An experienced anesthesiologist is associated with lower incidence of laryngospasm. Airway management is the most essential part of treatment of laryngospasm. Drugs can be used as an adjunct in treatment of laryngospasm, especially when anesthesia is administered by beginners.
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Human immunodeficiency virus (HIV) infection is one of the major global health problems. Because the advances in treatment of HIV infection increase the patient's survival, anaesthesiologists may care for these patients during their practice. This article highlights HIV infection and anaesthetic implications. ⋯ Anaesthesia in HIV-infected patients should be individualized and depend on the status of the patient.
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Curr Opin Anaesthesiol · Jun 2009
ReviewCan we predict persistent postoperative pain by testing preoperative experimental pain?
Although it is recognized that medical and surgical procedures may lead to persistent postoperative pain, predicting which patients are at risk for developing chronic pain presents an ongoing challenge. Clinical observations indicate that similar invasive procedures associated with consequent peripheral tissue damage can cause a wide range of pain experience. This broad variability is likely a consequence of the diversity in the central pain processing of the peripherally generated noxious stimulation. Therefore, advanced psychophysical measures that dynamically represent central pain modulation mechanisms may be used to determine an individual's susceptibility to developing persistent postoperative pain. This review highlights how, and to what extent, preoperative experimental pain testing can be utilized in predicting persistent postoperative pain. ⋯ The preoperative identification of individuals who have enhanced pain sensitivity and are at risk for developing persistent postoperative pain is important to providing them with better treatment that is specifically tailored to their altered pain modulation, as represented psychophysically.
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Curr Opin Anaesthesiol · Jun 2009
ReviewPresent and emerging strategies for reducing anesthesia-related maternal morbidity and mortality.
As the demographic of pregnant women continues to change, anesthesiologists will need to continue to find new ways to prevent morbidity and mortality. In this article several new and emerging strategies to meet this challenge are discussed. ⋯ Over the past 50 years, the field of anesthesiology has reduced the rates of anesthesia-related maternal mortality and major morbidity considerably. As the obstetric demographic becomes older and more obese, new technologies and strategies can assist in keeping maternal death and major morbidity vanishingly rare.
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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.