Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2019
ReviewEpidural test dose in obstetric patients: should we still use it?
As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue. ⋯ Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended-low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a 'traditional' test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.
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Curr Opin Anaesthesiol · Jun 2019
ReviewPostpartum hemorrhage revisited: new challenges and solutions.
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality in the United States, and worldwide. Recognition of PPH is challenging, but once hemorrhage is recognized, management needs to focus on achieving adequate uterine tone and maintaining maternal hemodynamic stability. There have been several advances in the management of postpartum hemorrhage, many of which can be implemented at the labor and delivery unit level. ⋯ Although postpartum hemorrhage itself may not be preventable, early identification of blood loss, and mobilization of resources may prevent adverse outcomes. Multidisciplinary planning at the system level, ensuring that hemorrhage protocols exist, as well as for management of high-risk patients is important for improving patient outcomes.
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Curr Opin Anaesthesiol · Jun 2019
ReviewPerioperative fluid management in children: can we sum it all up now?
The composition and type of intravenous fluids during paediatric anaesthesia have been subjects of debates for decades. Errors in perioperative fluid management in children may lead to serious complications and a negative outcome. Therefore, in this review, historical and recent developments and recommendations for perioperative fluid management in children are presented, based on physiology and focused on safety and efficacy. ⋯ Physiologically composed balanced isotonic electrolyte solutions are beneficial for maintaining homeostasis, shifting the status more towards the normal range in patients with preexisting imbalances and have a wide margin of safety in case of accidental hyperinfusion.
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Curr Opin Anaesthesiol · Jun 2019
ReviewLow-dose spinal anesthesia for cesarean section to prevent spinal-induced hypotension.
Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. ⋯ Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training.
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Curr Opin Anaesthesiol · Jun 2019
ReviewIs opioid-free general anesthesia for breast and gynecological surgery a viable option?
Opioid-free general anesthesia is a viable anesthetic technique for breast and gynecological surgery.
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