Current opinion in anaesthesiology
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Recent literature on the role of transthoracic echocardiography in the management of women with preeclampsia is reviewed with emphasis on recommendations for its use in the life-threatening complications of acute pulmonary edema, chest pain, and hemorrhage. ⋯ The role of transthoracic echocardiography in the management of women with preeclampsia is emphasized by international groups. Research into the hemodynamics in preeclampsia, which demonstrates preserved ejection fraction, and diastolic dysfunction highlights its utility and acceptability by pregnant women with preeclampsia. Training of obstetric anesthesiologists in echocardiography is necessary to enable more widespread implementation of this important technology.
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Curr Opin Anaesthesiol · Jun 2015
ReviewUpdate on perioperative care of the cardiac patient for noncardiac surgery.
The current review will address key topics and recommendations of the recent 2014 update of the American College of Cardiology and American Heart Association clinical practice guideline for the perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. ⋯ In conclusion, this review will discuss the important topics from the 2014 American College of Cardiology/American Heart Association guideline in order to provide the perioperative physician with the most recent evidence necessary to minimize major adverse cardiac events in patients undergoing noncardiac surgery.
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Hypoxic-ischemic brain injury is a leading cause of mortality and morbidity in neonates. Treating such injury by interrupting the excitotoxic-oxidative cascade is of immense importance. This review will focus on novel techniques of neuroprotection and describe the latest advances in established therapeutic methods. ⋯ Significant advances have occurred in the management of neonatal brain injury. With establishment of the optimal temperature and duration of hypothermia, combinatory therapies using adjuncts hold the greatest promise. Promising preclinical approaches such as stem cell-based therapy and use of noble gases need to be confirmed with clinical trials.
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Pre-operative oral carbohydrate decreases postoperative insulin resistance, speeds gastrointestinal functional recovery and reduces hospital stay, most significantly after major surgery.
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Curr Opin Anaesthesiol · Jun 2015
ReviewTransfusion and coagulation management in major obstetric hemorrhage.
Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. ⋯ A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.