Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Jun 2018
ReviewClinical pearls part 3: anaesthetic management of abnormally invasive placentation.
Abnormal placentation is a clinical condition seen increasingly in the pregnant population. It is associated with significant morbidity and mortality, which may be mitigated through robust multidisciplinary care for these patients. The role of maternal critical care for these patients has largely been ignored in the literature. ⋯ A robust protocol outlining the key elements of the management of placenta accreta, including optimizing postoperative care, should be in place to promote desired outcomes.
-
Curr Opin Anaesthesiol · Jun 2018
ReviewAcute pain management in children: challenges and recent improvements.
The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain. ⋯ Treatment options have evolved in recent years, including the combinations of multimodal regimens and regional anesthetic techniques. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids.
-
Curr Opin Anaesthesiol · Jun 2018
ReviewLong-term neurocognitive outcomes following surgery and anaesthesia in early life.
Repeated controversial and alarming statements of the potential dangers of anaesthetic agents on neurological outcomes in children continue to be issued based primarily on preclinical studies. This review assesses the current evidence of laboratory and clinical data and identifies areas of concerns. ⋯ It is biologically plausible that anaesthetic agents may induce structural changes during mammalian brain development and beyond. However, in the absence of alternatives the impact of the choice of anaesthetic drugs on long-term neurocognitive outcomes is almost certainly to be of limited relevance in humans. The underlying disease processes, surgical intervention, and trauma as well as other known perioperative factors more significantly affect these outcomes.
-
Hysterectomy is a common surgical procedure with a low risk of major complications. However, some women experience long-lasting complications, including chronic postsurgical pain, which can have a negative impact on their quality of life. This review aims to present the recent literature on chronic pain following hysterectomy for benign indications. ⋯ Chronic pain may occur after hysterectomy. Preoperative screening tools, including psychological screening for depression and anxiety, may identify women at risk of developing chronic postsurgical pain, and future studies should examine perioperative interventions aimed at preventing the development of chronic pain after hysterectomy.