Current opinion in anaesthesiology
-
The review is intended to serve as a practical clinical aid for the clinician called to maternal cardiac arrest. ⋯ Maternal cardiac arrest should be managed similarly to other adult cardiac arrests. At the same time its unique reversible causes require a different form of thought regarding diagnosis and treatment during the code.
-
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.
-
With the ageing population, there is an increasing number of patients with a neurocognitive disorder (NCD) who undergo surgical procedures. The aim of this review is to highlight the epidemiology of preoperative NCD. ⋯ Cognitive dysfunction is common prior to surgery. Awareness of dysfunction, especially when taking care of older adults, is critical given the high risk of complications in this population.
-
Curr Opin Anaesthesiol · Jun 2019
ReviewRecent advances in diabetes treatments and their perioperative implications.
The implications for perioperative management of new oral antihyperglycemic medications and new insulin treatment technologies are reviewed. ⋯ Sulfonylureas and SGLT2i should be ceased before moderate or major surgery. Other oral antihyperglycemic therapies may be continued or ceased. Complex patients and/or new therapies require specialized multidisciplinary management.
-
In recent years, ultrafast-track anesthesia with on-table extubation and concepts of accelerated postoperative care have gained increasing support in pediatric congenital cardiac surgery. It is believed that such approaches might ideally combine economic benefits with a striving for continuous improvement of patient outcomes. The present review summarizes the role of dexmedetomidine (DEX) in this setting. ⋯ Due to a favorable mix of beneficial physiologic actions and a limited adverse effect profile, DEX is established in the perioperative pediatric cardiac surgery setting. However, evidence from high-quality randomized controlled trials on the effects of supplemental DEX on meaningful patient outcomes is scarce, and research on the role of DEX in providing cardioprotection, neuroprotection, or renoprotection is still at its beginning. DEX has developed to one of the main agents in the armamentarium of cardiac anesthesiologists and pediatric intensivists, but it should not be regarded as the new 'magic bullet'.