Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2013
ReviewAnesthesia for the patient with congenital heart disease presenting for noncardiac surgery.
To summarize recent publications emphasizing the changes in the population of patients with congenital heart disease and trends in the anesthetic and perioperative care of these patients presenting for noncardiac procedures. ⋯ The identification of high-risk patients, multidisciplinary decision-making and planning and careful anesthetic management and monitoring are critical for optimizing outcomes in children with congenital heart disease presenting for noncardiac procedures.
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To describe adolescent development within the context of perioperative anesthetic management. ⋯ Adolescents are a very healthy population subject to unintentional and intentional injury. Emotional and judgmental maturation is a cofactor in these injuries, better appreciated through improved understanding of developmental neurobiology. In addition, increases in muscle mass, requirements for nutrition and rest, maladaptive behavior, and health choices are important for optimal perioperative care.
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Curr Opin Anaesthesiol · Jun 2013
ReviewProphylaxis and treatment of the side-effects of neuraxial morphine analgesia following cesarean delivery.
Neuraxial morphine is commonly used for analgesia after cesarean delivery, but is frequently associated with postoperative nausea and vomiting (PONV) and pruritus. This review describes the recent advances in the management of those side-effects. ⋯ PONV and pruritus are frequent side-effects of neuraxial morphine. Future studies investigating combination antiemetic therapy, long-acting antiemetics, and strategies to manage pruritus are needed.
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Curr Opin Anaesthesiol · Jun 2013
ReviewRole of transversus abdominis plane block after caesarean delivery.
The transversus abdominis plane (TAP) block is a relatively new regional anaesthesia technique that has shown analgesic benefit in abdominal and pelvic surgery. There has been recent interest in expanding this regional technique to enhance analgesia following caesarean delivery. ⋯ The TAP block significantly improves postoperative analgesia and reduces opioid consumption and opioid-related side-effects in women undergoing caesarean delivery who did not receive intrathecal morphine.
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Professional society guidelines recommend that women with breech presentation be delivered surgically due to a higher incidence of fetal risks compared with vaginal delivery. An alternative is attempted external cephalic version, which if successful, enables attempted vaginal delivery. Attitudes towards external cephalic version (ECV) will be considered in this review, along with pain relief methods and their impact on ECV success rates. ⋯ The logistics of routine ECV and provision of optimal neuraxial techniques for successful ECV require additional research. Safety aspects of neuraxial anesthesia for ECV require further investigation.