Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2018
ReviewA different perspective: anesthesia for extreme premature infants: is there an age limitation or how low should we go?
To put in perspective, the various challenges that faces pediatric anesthesiologists because of the recently lowered limits with regards to the viability of a fetus. Both medical and ethical considerations will be highlighted. ⋯ There does currently not exist sufficient research data to provide any evidence-based guidelines for the anesthetic handling of extreme premature infants. Current practice relies on extrapolations from other patient groups and from attempting to preserve normal physiology. Thus, focused research initiatives within this specific field of anesthesia should be a priority. Furthermore, in-depth multiprofessional ethical discussions regarding long-term outcome of aggressive care of extremely premature babies are urgently needed, including the new concepts of disability-free survival and number-need-to-suffer.
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Curr Opin Anaesthesiol · Jun 2018
ReviewPreoperative fasting guidelines in pediatric anesthesia: are we ready for a change?
Study after study shows that prolonged fasting before anesthesia is common in children. Pediatric anesthesiologists around the world are concerned that the current guidelines may be part of the problem. This review focuses on what can be done about it. ⋯ Accumulating evidence indicates that changes of the current guidelines for preoperative fasting should be considered for children undergoing elective procedures. VIDEO ABSTRACT.
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Assessment of the current literature surrounding interventions directed toward the prevention of burnout in the field of medicine and particularly in anesthesiology. ⋯ There remains no clear or definitive intervention to prevent burnout for physicians. However, changing our environment to embrace mentorship, the continual exchange of feedback and the fostering self-care could startlingly improve our work environment.
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Curr Opin Anaesthesiol · Jun 2018
ReviewOccupational stress, burnout and personality in anesthesiologists.
There is a growing awareness of the problem of occupational stress and burnout among anesthesiologists. Occupational stress was found to be related to burnout, a process that is supposed to be moderated by personality. This article will discuss the topic of stress and burnout in relationship to anesthesiologists' personality based on recent literature. ⋯ Strategies to alleviate stress and hence the development of burnout should not only be directed at adapting occupational or organizational factors but also at equipping anesthesiologists with psychological tools to deal with occupational stress. Furthermore, personality traits that predispose for development of burnout could be taken into consideration in resident selection procedures.
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Curr Opin Anaesthesiol · Jun 2018
ReviewThe opioid epidemic and pregnancy: implications for anesthetic care.
This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. ⋯ The dramatic rise in OUD in pregnancy has had staggering socioeconomic consequences, carrying with it profound maternal and fetal health problems. Medication-assisted treatment utilizing either methadone, or more commonly buprenorphine, is considered the standard of care for OUD during pregnancy. Peripartum pain management for opioid-tolerant patients is challenging and requires consideration for regional anesthesia along with multimodal pharmacotherapy.