Current opinion in anaesthesiology
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Prediction of postoperative pulmonary complications (PPCs) enables individually applied preventive measures and maybe even early treatment if a PPC eventually starts to develop. The purpose of this review is to describe crucial steps in the development and validation of prediction models, examine these steps in the current literature and describe what the future holds for PPC prediction. ⋯ Many predictive models for PPCs have been reported on. Development of more robust PPC prediction models could be supported by machine learning.
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Curr Opin Anaesthesiol · Jun 2019
ReviewCentral neurological complications following obstetric neuraxial blockade.
Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence. ⋯ Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.
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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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The purpose of this review is to describe the anesthesiologist's perioperative challenges when caring for the patient with substance use disorder and, in particular, opioid use disorder. ⋯ Patients with substance use disorders and, in particular, those addicted to opioids, present a challenge to the anesthesiologist. Whether the diagnosis of substance use disorder is known or unknown and whether on maintenance therapy, in withdrawal, or remission, patients with this condition represent a special surgical population whose perioperative care can influence their postoperative and disease course for many years.
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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.