Current opinion in anaesthesiology
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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
ReviewPostcaesarean section analgesia: are opioids still required?
The use of opioids for postoperative pain relief after caesarean section is widely spread. Because of unwanted well known side-effects, alternative drugs and methods of pain relief have been introduced, either in addition to or instead of opioids. Can postcaesarean analgesia be achieved these days without opioids? ⋯ The dependency on opioids for postcaesarean analgesia is diminishing, but in order to develop effective, well tolerated alternatives, more research is needed.In the meantime, opioids are here to stay.
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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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Spinal anesthesia has long been described as a well-tolerated and effective means of providing anesthesia for infants undergoing lower abdominal surgery. Now, spinal anesthetics are being used for an increasing variety of surgeries previously believed to require a general anesthetic. This, along with increasing concerns over the neurocognitive effects of general anesthetics on developing brains, suggests that further exploration into this technique and its effects is essential. ⋯ Early findings of spinal anesthesia exposure in infancy have shown it to have no independent effect on neurocognitive delay as well as to provide sound cardiorespiratory stability. With safer means of administering a spinal anesthetic, such as with ultrasound guidance, it is a readily available and desirable tool for those providing anesthesia to infants.
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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.