Current opinion in anaesthesiology
-
Perioperative β-blocker use should be tailored for patient and surgical risk factors, most importantly because of the association with increased mortality and stroke when their use is generalised.
pearl -
The objective of this review is to identify the potential of peripheral nerve blocks established over the last years for perioperative pain management in breast surgery. These new blocks will be discussed with respect to their clinical effect and necessity. ⋯ Taking the pain levels after breast surgery into account, the request of additional nerve blocks has to be pondered against the potential risks and resource requirement. To reduce or avoid intraoperative or postoperative opioids, an ultrasound-guided Pecs II block proves to be the best option for perioperative pain relief.
-
Simulation training (crew resource management training and scenario training) has become an important tool in the education of anesthesiologists. This review summarizes recent research performed in this area, focusing more specifically on obstetric anesthesia. ⋯ Simulation training has acquired a central role in modern education of anesthesiologists. Further research regarding elements to optimize simulation training in terms of learning outcomes and long-term skill retention is desirable. In addition, little data exist concerning the effect of simulation training on possible improvement of patient outcomes in anesthesia.
-
Curr Opin Anaesthesiol · Jun 2020
ReviewPractice horizons in pediatric nonoperating room anesthesia.
Anesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients. ⋯ With appropriate attention to organizational concerns (i.e. team environment, safety protocols) and unrelenting focus on patient safety, anesthesiologists can assist in safely providing the benefit of cutting-edge technical advancements to pediatric patients in these challenging environments.
-
Curr Opin Anaesthesiol · Jun 2020
ReviewHypotension after spinal anesthesia for cesarean section: how to approach the iatrogenic sympathectomy.
Hypotension during cesarean section remains a frequent complication of spinal anesthesia and is associated with adverse maternal and fetal events. ⋯ Current evidence favors a combined approach of low-dose spinal anesthesia, adequate fluid therapy and vasopressor support to address maternal spinal-induced hypotension. As none of the available vasopressors is associated with relevantly impaired maternal and fetal outcomes, none of them should be abandoned from obstetric practice. Rapid crystalloid co-loading is of equivalent efficacy as compared with colloids and should be preferred because of a more favorable risk profile.