Current opinion in anaesthesiology
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For most anaesthesiologists, the clinical experience with general anaesthesia for caesarean section is very low. General anaesthesia is mostly performed for emergency grade 1 caesarean section and due to a lack of time to apply a neuraxial anaesthesia technique. Unfortunately, the majority of anaesthesiologists rely on historical and partly outdated approaches in this stressful situation. We propose an evidence-based approach to general anaesthesia for caesarean section. ⋯ We present a review of recent evidence on general anaesthesia for caesarean section.
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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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Curr Opin Anaesthesiol · Jun 2015
ReviewAnesthesiological considerations for children with obstructive sleep apnea.
To summarize recent evidence-based data regarding outcomes associated with children who have obstructive sleep apnea (OSA). ⋯ Perioperative deaths in children with OSA occur at a low frequency. Hypoxia-induced opioid sensitivity combined with an approximate 1-2% incidence of rapid conversion of codeine to morphine suggest the need for new approaches for providing preoperative assessment of risk, extended postoperative observation and the need for alternative opioids to codeine. Additionally, new less painful surgical approaches may help to reduce postoperative opioid requirements and therefore perhaps less risk for opiate-induced apnea in this vulnerable population.
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The aim of this review is to discuss recent developments in vascular access technology and to highlight those that are particularly relevant to the practitioner. ⋯ Despite the development of new technical devices, successful venous puncture remains heavily dependent on the skills of the operator.
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Curr Opin Anaesthesiol · Jun 2015
ReviewMaternal critical care: 'one small step for woman, one giant leap for womankind'.
The purpose of this study is to outline the challenges of looking after women who either become or are at a risk of becoming critically ill during pregnancy. ⋯ In this review, we identify the need for maternal critical care, explore different models of its provision and outline possible benefits and barriers to its future implementation.