Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2013
ReviewAnaesthesia or sedation for paediatric MRI: advantages and disadvantages.
The purpose of the present review is to place the current literature into historical context of what is understood about the conceptual as well as practical differences between sedation and anaesthesia, and what the potential benefits and risks may be, where paediatric imaging is concerned. ⋯ One single method cannot be applied to all children. Many can be sedated, but others will need anaesthesia with careful airway management, and the accompanying skilled personnel. Service models should be developed and tested to ensure maximum efficiency of service delivery.
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Curr Opin Anaesthesiol · Aug 2013
ReviewRegional anesthesia for trauma outside the operating theatre.
Pain management in the trauma patient can be challenging, especially outside the operating room setting. Traditional analgesics such as opioids and NSAIDs are also problematic in trauma care. In this review, the use of regional anesthetic techniques outside the operating theatre is discussed. ⋯ Pain is often poorly managed in the trauma patient. In addition to quality analgesia, regional anesthesia provides a variety of benefits in the trauma setting outside the traditional operating room setting. While further utilization requires increased training and structural changes, existing tools such as ultrasound are removing barriers to the widespread use of peripheral nerve block techniques across multiple disciplines.
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Curr Opin Anaesthesiol · Aug 2013
ReviewInterventional radiology in the pregnant patient for obstetric and nonobstetric indications: organizational, anesthetic, and procedural issues.
As indications for interventional radiology procedures during pregnancy continue to expand, anesthesiologists must be aware of the indications for specific procedures as well as provide the safest possible anesthetic care to both the mother and the fetus in nontraditional environments. ⋯ The risk to the fetus of the imaging procedure must be weighed against the benefit to the mother of early and accurate diagnosis and treatment of the underlying pathology. As the organizational aspects of providing care become more complex, simulation, guidelines, and protocols may become important to the safe care of these patients.
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Curr Opin Anaesthesiol · Aug 2013
ReviewContinuous renal replacement therapy with regional citrate anticoagulation: do we really know the details?
A significant proportion of critically ill patients with acute kidney injury require continuous renal replacement therapy (CRRT). This article summarizes current evidence on the diagnosis and treatment of acute kidney injury. Regional citrate anticoagulation (RCA) is an emerging but complex technique. A variety of solutions and systems are currently used for RCA. Descriptions of the dosage and methods differ significantly and may cause confusion in everyday practice. This article reviews important scientific findings and highlights pharmacological and pathophysiological aspects of RCA, with a special emphasis on practical clinical issues regarding dosage and available citrate solutions. ⋯ RCA-CRRT is a technique that can be safely used in the majority of intensive care patients with severe multiple-organ failure. The range of citrate solutions available, the different methods in use--continuous venovenous haemofiltration, continuous venovenous haemodialysis and continuous venovenous haemodiafiltration--and the lack of a generally accepted complete CRRT 'set' have impeded implementation of the technique in clinical practice. Unresolved questions regarding dosage and assessment preclude evidence-based comparison in prospective, multicentre studies. For the moment, each institution has to develop a local working protocol. In clinical practice, detailed staff training and monitoring of possible metabolic disturbances for this complex intervention is essential.
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Many studies of new intravenous sedative drugs have been published last year, including several phase I trials. This review provides a brief summary of these studies, with recommendations for selected reading. ⋯ Many of the new sedative drugs were designed to undergo rapid metabolism. Remimazolam has great potential to enter clinical practice because of its rapid offset of action.