Current opinion in anaesthesiology
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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.
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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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Curr Opin Anaesthesiol · Jun 2015
ReviewIntraoperative hypotension in neonates: when and how should we intervene?
Organ hypoperfusion remains an important cause of postoperative morbidity in neonates. Blood pressure (BP) is frequently mistakenly used as a surrogate of organ perfusion and the predictive value of BP for outcome is unclear. The current article will focus on the role of BP in the optimization of organ perfusion during anaesthesia in neonates. ⋯ Anaesthetic management should focus on optimizing organ perfusion and not merely on maintaining a particular BP. A collaborative approach is recommended. The carbon dioxide tension is crucial to perfusion in the presence of cardiovascular shunts.
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Curr Opin Anaesthesiol · Jun 2015
ReviewBlood conservation strategies and the management of perioperative anaemia.
Anaemia is a global health problem with particularly high prevalence in the perioperative setting and it can significantly affect the patient outcomes. This review addresses new findings on the significance of anaemia and patient blood management (PBM) strategies to prevent and manage anaemia. ⋯ Despite the high prevalence of anaemia and the significant toll it takes on patients, simple and effective strategies are available to detect, diagnose and treat it.