Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2019
ReviewThe malnourished surgery patient: a silent epidemic in perioperative outcomes?
As many as two of every three major surgery patients are malnourished preoperatively - a diagnosis rarely made and treated even less frequently. Unfortunately, perioperative malnutrition is perhaps the least often identified surgical risk factor and is among the most treatable to improve outcomes. ⋯ The recent publication of new surgical nutrition guidelines, the PONS score, and use of LBM assessments will allow better identification and earlier intervention on perioperative malnutrition. It is essential that in the future no patient undergoes elective surgery without nutrition screening and nutrition intervention when malnutrition risk is identified.
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Curr Opin Anaesthesiol · Jun 2019
ReviewAnesthesia for predelivery procedures: ex-utero intrapartum treatment/intrauterine transfusion/surgery of the fetus.
The aim of this study was to review the current literature on anesthesia for predelivery procedures and to summarize recent findings on anesthesiological methods used. ⋯ Predelivery procedures require a differentiated anesthesia approach depending on the invasiveness of the intervention. Anesthesia ranges from monitored care to neuraxial anesthesia and general anesthesia. Depending on the procedure uterine relaxation and fetal immobilization are crucial for technical success. Interdisciplinary consultation optimizes the anesthesia plan for complex procedures.
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This review summarizes the current evidence available to guide anaesthetists along the decision-making process between inhalational and intravenous anaesthesia when caring for paediatric patients. ⋯ For children scheduled for elective surgery, intravenous induction has significant advantages with regards to reduced respiratory adverse events and for less postoperative behavioural disturbances, it may be associated with more anxiety at the time of induction. The anaesthetist in charge of the patient needs to weigh up the balance between the clinical risk of respiratory adverse events, the 'veins on offer', the level of anxiety and previous experiences of the child and his/her parents.
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Curr Opin Anaesthesiol · Jun 2019
ReviewPharmacokinetic-pharmacodynamic population modelling in paediatric anaesthesia and its clinical translation.
Pharmacokinetic-pharmacodynamic (PKPD) population modelling has advanced adult anaesthesia. Current literature was reviewed to discern use of this analytic technique for benefit in the perioperative management of children. ⋯ Modelling and simulation continue to have an important role optimizing drug use during anaesthesia. Models incorporating influential covariates that better describe drug pharmacokinetics and pharmacodynamics improve anaesthetic treatments and safety in diverse populations and clarify drug role and impact. Their use developing paediatric clinical studies improves trial conduct, often with fewer subjects required for study.
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Curr Opin Anaesthesiol · Jun 2019
ReviewAnaesthetic neuroprotection in children: does it exist or is it all just bad?
In the last 20 years, data from studies of laboratory animals, including nonhuman primates, have provided ample evidence that general anaesthetic drugs cause pathological changes in developing central nervous system (neurotoxicity). Recently, a new area of research has been developed in order to recognize any possible actions that can attenuate anaesthetics neurotoxicity. This review aims to provide an overview of the recent literature on neuroprotection. ⋯ Recent literature largely explores a variety of solutions in order to preserve and reduce the damage caused by anaesthetic agents. At the moment, none of the presented solutions regarding neuroprotection is applicable in clinical setting. Further research studies are needed.