Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2015
ReviewTransfusion and coagulation management in major obstetric hemorrhage.
Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. ⋯ A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.
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For most anaesthesiologists, the clinical experience with general anaesthesia for caesarean section is very low. General anaesthesia is mostly performed for emergency grade 1 caesarean section and due to a lack of time to apply a neuraxial anaesthesia technique. Unfortunately, the majority of anaesthesiologists rely on historical and partly outdated approaches in this stressful situation. We propose an evidence-based approach to general anaesthesia for caesarean section. ⋯ We present a review of recent evidence on general anaesthesia for caesarean section.
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Curr Opin Anaesthesiol · Jun 2015
ReviewAnesthesiological considerations for children with obstructive sleep apnea.
To summarize recent evidence-based data regarding outcomes associated with children who have obstructive sleep apnea (OSA). ⋯ Perioperative deaths in children with OSA occur at a low frequency. Hypoxia-induced opioid sensitivity combined with an approximate 1-2% incidence of rapid conversion of codeine to morphine suggest the need for new approaches for providing preoperative assessment of risk, extended postoperative observation and the need for alternative opioids to codeine. Additionally, new less painful surgical approaches may help to reduce postoperative opioid requirements and therefore perhaps less risk for opiate-induced apnea in this vulnerable population.
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Curr Opin Anaesthesiol · Jun 2015
ReviewMaternal critical care: 'one small step for woman, one giant leap for womankind'.
The purpose of this study is to outline the challenges of looking after women who either become or are at a risk of becoming critically ill during pregnancy. ⋯ In this review, we identify the need for maternal critical care, explore different models of its provision and outline possible benefits and barriers to its future implementation.