Current opinion in anaesthesiology
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The current review considers an array of recent applications for point-of-care ultrasound in clinical practice including diagnostic and therapeutic procedures that may be relevant for the obstetric anesthesiologist. The rapid advancement of technology and clinical applications for bedside ultrasound in obstetric anesthesiology requires an appraisal of the limitations and uses. ⋯ Anesthesiologists have clearly embraced this facile versatile tool for bedside diagnostics and procedures. One limitation to widespread adoption is availability of suitable ultrasound skills and technology. Many of these ultrasound techniques have not yet established clear patient benefit, yet the sheer breadth of ultrasound techniques reported in the past few years demonstrate that our colleagues are becoming more proficient. It is important to follow the development of this emerging field to be aware of limitations to learning these skills and their potential clinical benefit. Proficiency in some of these point-of-care ultrasound techniques may become prerequisite for obstetric anesthesiologists to provide the best care.
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Adverse long-term impact of general anesthesia on the developing brain is a widely discussed and controversial issue with potential public health relevance. The goal of this article is to give insights into the most recent experimental and clinical observations aimed to advance our understanding in this field. ⋯ Experimental data with reasonable translational relevance suggest that early-life exposure to general anesthetics can induce lasting behavioral and cognitive deficits. In contrast, human studies provide, at best, mixed evidence about developmental anesthesia neurotoxicity. Future research, both experimental and human, is needed to clarify this important issue.
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In order for the obstetric anesthesiologist to become a true perioperative / peripartum physician, a change in formative programs and certification process in anesthesia are needed. ⋯ The obstetric population is becoming a higher risk population, requiring an obstetric anesthesiologist taking on the role of a perioperative / peripartum physician. It is essential that anesthesia training programs migrate to CBME through simulation-based curriculum that allow the achievement of nontechnical skills and team work competencies. It is also essential that regular certification for specialist anesthesiologists occur throughout their entire career.