Current opinion in anaesthesiology
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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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The expected difficult airway in children is a rare, but predictable entity, which can lead to life-threatening situations, when sufficient oxygenation and ventilation cannot be achieved. This review gives an overview on current techniques and recommendations on where, who, when, and how to treat children with expected difficult airway. ⋯ The expected difficult airway in children is predictable by clinical signs and medical history in most of the cases and therefore anticipative. It should always be managed in specialized centers. In emergency situations, optimized face mask ventilation (aided by an oropharyngeal/nasopharyngeal airway) or ventilation via supraglottic airway devices or a nasopharyngeal tube can be most helpful skills until definitive airway management is available. These emergency techniques should be taught regularly in all anesthesia departments where children present for elective and nonelective surgery.
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Curr Opin Anaesthesiol · Jun 2015
ReviewPatient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider.
Remifentanil is a relatively new but commonly used opioid alternative in the management of labor pain relief. The present article evaluates efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief. ⋯ Remifentanil PCIA is a valuable analgesic strategy whenever regional analgesia is contraindicated. Using it as first line strategy seems to be contraindicated because of significant respiratory side-effects to the mother. Whenever used advanced and continuous monitoring using capnography, saturation monitoring and one-to-one midwifery care are mandatory!
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The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. ⋯ This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps in regulations, teaching and research. Defining the 'who', 'where', 'when' and 'how' in this context provides the framework for the safe conduct of pediatric anesthesia.