Current opinion in anaesthesiology
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Difficulties in pediatric airway management are common and continue to result in significant morbidity and mortality. This review reports on current concepts in approaching a child with a difficult airway. ⋯ The healthy child with an unexpected airway problem requires clear strategies. The 'impaired' normal pediatric airway may be handled by anesthetists experienced with children, whereas the expected difficult pediatric airway requires dedicated pediatric anesthesia specialist care and should only be managed in specialized centers.
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Curr Opin Anaesthesiol · Jun 2012
ReviewShould antifibrinolytics be given in all patients with trauma?
Hemorrhage is the second most important cause of death in patients with trauma, contributing to approximately 30% of trauma-related mortality. Pharmacological prohemostatic agents may be useful adjunctive treatment options in patients with severe blood loss. ⋯ In view of this efficacy and safety of this relatively cheap and simple drug, it may be recommended to put tranexamic acid in the first (maybe even prehospital) line of management of patients with severe traumatic hemorrhage.
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Common colds are infections of mostly viral origin that frequently occur in childhood. The overall anesthetic risk in children with respiratory tract infections is increased because of the increased incidence of perioperative respiratory adverse events (PRAEs). Although the morbidity and mortality of PRAE are low when managed by experienced anesthesiologists, careful preoperative assessment and perioperative anesthetic care are indispensable. ⋯ Children with a cold can be safely anesthetized under certain circumstances; however, anesthesia in children with symptomatic infections with wheezing, purulent secretion, fever and reduced general condition should be postponed for at least 2 weeks. Anesthetic treatment options for children with infection of the upper airway with a runny nose and cough include preoperative inhalational therapy with salbutamol, avoidance of endotracheal intubation whenever possible, use of a face mask or laryngeal mask, intravenous induction with propofol and avoidance of desflurane. Prevention, early recognition and immediate treatment of complications by an experienced anesthesiologist are crucial.
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To guide the optimal fluid management during cesarean delivery. The article focuses on fluid management to prevent hypotension during cesarean delivery performed under spinal anesthesia and excludes obstetric hemorrhage. ⋯ Current evidence suggests that combining a prophylactic vasopressor regimen with HES preloading, HES coloading or crystalloid coloading is the best method of preventing maternal hypotension after the initiation of spinal anesthesia. Crystalloid preloading is clinically ineffective and thus should no longer be used.
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This review assesses the maternal and fetal effects of vasopressor administration during spinal anaesthesia for caesarean delivery, with emphasis on recent findings. ⋯ Phenylephrine is the current vasopressor of choice for the prevention of maternal hypotension and nausea. Phenylephrine regimens need to be developed that can reliably and safely be used with noninvasive blood pressure cycle times less frequent than every minute. Further vasopressor should be used with caution when vagolytic therapy is, quite rightly, used to treat bradycardia associated with hypotension.