Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2022
ReviewSafe in the first attempt: teaching neonatal airway management.
Quick and precise facemask ventilation and tracheal intubation are critical clinical skills in neonatal airway management. In addition, this vulnerable population requires a thorough understanding of developmental airway anatomy and respiratory physiology to manage and anticipate potential airway mishaps. Neonates have greater oxygen consumption, increased minute ventilation relative to functional residual capacity, and increased closing volumes compared to older children and adults. After a missed airway attempt, this combination can quickly lead to dire consequences, such as cardiac arrest. Keeping neonates safe throughout the first attempt of airway management is key. ⋯ Every neonatal intubation should be considered a critical event. Below we discuss some of the challenges in neonatal airway management, including anatomical and physiological principles which must be understood to approach the airway. We then follow with a description of current evidence for best practices and training.
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Health equity is an important priority for obstetric anesthesia, but describing disparities in perinatal care process and health outcome is insufficient to achieve this goal. Conceptualizing and framing disparity is a prerequisite to pose meaningful research questions. We emphasize the need to hypothesize and test which mechanisms and drivers are instrumental for disparities in perinatal processes and outcomes, in order to target, test and refine effective countermeasures. ⋯ Measuring social determinants of health and meaningful perinatal processes and outcomes precisely and accurately at the individual, family, community/neighborhood level is a prerequisite for healthcare disparity research. A focus on elucidating the precise mechanism driving disparity in processes of obstetric care would inform a more rational effort to promote health equity. Implementation scientists should rigorously investigate in prospective trials, which countermeasures are most efficient and effective in mitigating perinatal outcome disparities.
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Curr Opin Anaesthesiol · Jun 2022
ReviewRacial and ethnic disparities in access to gynecologic care.
Despite efforts to minimize patient barriers to equitable care, health disparities persist in gynecology. This paper seeks to highlight racial and ethnic disparities in gynecologic care as represented by recent literature. ⋯ As we identify these social disparities in healthcare, we gain valuable knowledge of where our efforts are lacking and where we can further improve the health of women. Future research should focus on identifying and combating such disparities with measurable changes in health outcomes.
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Curr Opin Anaesthesiol · Jun 2022
ReviewHow to optimize the perioperative care of patients with orphan diseases: what the anesthesiologist needs to know.
Despite a very low individual prevalence, rare or orphan diseases are estimated to collectively affect as much as 6-8% of the general population. These diseases provide a challenge to anesthetic delivery because of the lack of evidence to guide optimal management. ⋯ Improved access to resources of knowledge may allow for more informed anesthetic management of orphan diseases. The combination of a thorough review of existing knowledge about individual diseases and a structured anesthetic assessment may assist in the delivery of well tolerated anesthetic care of rare conditions.