Current opinion in anaesthesiology
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Labor is among the most painful experiences that humans encounter. Neuraxial analgesia is the most effective means of treating this pain. In this review, we discussed the effect of neuraxial analgesia on the progress of labor when compared with parenteral opioids. We then compared initiation of analgesia with a combined spinal-epidural technique (CSE) to conventional epidural analgesia. Finally we discussed the impact of neuraxial analgesia, given early in labor, compared with later administration. ⋯ Neuraxial analgesia does not interfere with the progress or outcome of labor. There is no need to withhold neuraxial analgesia until the active stage of labor.
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One of the newest strategies to enlarge the pool of organ donors is to consider the category of donors after cardiac death rather than only after brain death. Prompt and accurate identification of potential donors and appropriate care is necessary to optimize the management of nonheartbeating donors. ⋯ In order to increase the number of organs available for transplantation, donation from nonheartbeating donors has been recently proposed. Identification of the key aspects of the donation after cardiac death should be fully achieved by the team involved in the transplantation program. Development of hospital policies and identification of receivers who are most likely to benefit from this strategy require further studies to assess long-term outcome and to identify ethical aspects concerning different religious and cultural backgrounds.
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Curr Opin Anaesthesiol · Jun 2010
ReviewAnesthetic management of the patient with epilepsy or prior seizures.
Epilepsy is a clinical disorder of paroxysmal recurring seizures, the diagnosis excluding alcohol or drug withdrawal seizures or such recurring exogenous events as repeated insulin-induced hypoglycemia. Epilepsy has a profound impact on each individual diagnosed with this disease. ⋯ The primary concerns for providing anesthesia to the patient with epilepsy are the capacity of anesthetics to modulate or potentiate seizure activity and the interaction of anesthetic drugs with AEDs. Proconvulsant and anticonvulsant properties have been reported for virtually every anesthetic such that these properties become elements of the anesthetic plan in the patient with epilepsy. Moreover, AEDs have many physiologic and pharmacologic effects that can have an impact on an anesthetic.
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Patients with pulmonary hypertension who undergo anesthesia and surgery have high morbidity and mortality. Recent advances in our understanding of pulmonary hypertension and its therapy provide an opportunity to improve outcomes. ⋯ The cause of pulmonary hypertension should be defined in perioperative patients with pulmonary hypertension, and therapy should be optimized prior to anesthesia. Pulmonary artery catheterization may be required to confirm the presence of pulmonary hypertension and its severity. The focus of anesthetic management is to maintain right ventricular cardiac output and avoid systemic hypotension. Inhaled vasodilators such as nitric oxide and prostacyclin can be life-saving when perioperative right heart failure occurs due to exacerbation of pulmonary hypertension.