Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2010
ReviewPrevalence and predictors of chronic pain after labor and delivery.
Labor pain is a complex phenomenon with sensory, emotional, and perceptive components and can be regarded as one of the most serious kinds of pain. Different strategies to approach acute labor pain have been developed. Chronic pain after labor and delivery has not been studied so extensively. In this review recent findings about chronic pain after labor and delivery will be discussed. ⋯ Treatment of acute pain during labor and delivery is necessary to prevent chronic pain. Future studies should focus on the long-term effects of different analgesic regimens on the development of chronic pain after labor and delivery.
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Patients often receive preoperative therapies that interfere with hemostasis, and can present for surgery with underlying hemostatic disorders because of pre-existing preoperative anticoagulation or antiplatelet therapy. Perioperative bleeding can occur following surgery due to multiple causes; however, the addition of pharmacologic agents creates an acquired defect that complicates the surgical injury and may result in increased blood loss. An understanding of the potential impact of anticoagulation therapies on hemostasis is critical in managing these patients. Further, newer agents are evolving in clinical practice that clinicians should be aware of. ⋯ There are multiple pharmacologic therapies that surgical patients may be exposed to preoperatively, although there are currently few available methods to antagonize their effects. Often therapeutic prohemostatic pharmacologic approaches are used to treat or prevent bleeding, in addition to transfusional therapies.
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Curr Opin Anaesthesiol · Jun 2010
ReviewWhat are the current indications for noninvasive ventilation in children?
The aims of this paper are to examine the physiological rationale for noninvasive respiratory support (NRS) in children older than 1 month with acute respiratory failure, to review clinical available data and to give some practical recommendations for the safe application of NRS. ⋯ Preliminary clinical data show that NRS is safe and effective in children with acute respiratory failure.
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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.
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Curr Opin Anaesthesiol · Jun 2010
ReviewInside the black box: current policies and concerns with the United States Food and Drug Administration's highest drug safety warning system.
To evaluate the United States Food and Drug Administration use of the black-box warning system to promote drug safety and to examine the droperidol black-box warning as a case study. ⋯ Rather than relying on well conducted clinical investigations, the Food and Drug Administration subjectively issued a black-box warning to droperidol, which effectively removed droperidol from clinical practice for the indication of postoperative nausea and vomiting. Newer data suggest that the incidence of prolongation of the QT interval and the occurrence of torsades de pointes is similar to more expensive alternative medications used to treat postoperative nausea and vomiting.