Current opinion in anaesthesiology
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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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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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Neuraxial analgesia is considered the gold standard of labour analgesia as it provides the most effective method of pain relief during childbirth. In this article, we explore the recent advances in the initiation and maintenance of epidural analgesia. ⋯ We examine these recent developments in pump technology and epidural delivery systems and evaluate how these have enhanced the mothers' birthing experiences.
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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.