Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2013
ReviewRole of transversus abdominis plane block after caesarean delivery.
The transversus abdominis plane (TAP) block is a relatively new regional anaesthesia technique that has shown analgesic benefit in abdominal and pelvic surgery. There has been recent interest in expanding this regional technique to enhance analgesia following caesarean delivery. ⋯ The TAP block significantly improves postoperative analgesia and reduces opioid consumption and opioid-related side-effects in women undergoing caesarean delivery who did not receive intrathecal morphine.
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Professional society guidelines recommend that women with breech presentation be delivered surgically due to a higher incidence of fetal risks compared with vaginal delivery. An alternative is attempted external cephalic version, which if successful, enables attempted vaginal delivery. Attitudes towards external cephalic version (ECV) will be considered in this review, along with pain relief methods and their impact on ECV success rates. ⋯ The logistics of routine ECV and provision of optimal neuraxial techniques for successful ECV require additional research. Safety aspects of neuraxial anesthesia for ECV require further investigation.
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Perioperative visual loss (POVL) is an uncommon complication primarily associated with cardiac, spine, and head and neck surgery that can have a potentially severe impact on quality of life. The largest multicenter case control study to date on POVL recently identified risk factors associated with ischemic optic neuropathy and prone spinal fusion surgery. This review will summarize these findings and the updated American Society of Anesthesiologists practice advisory on POVL to provide guidance on identification and management of high-risk patients undergoing prone spine surgery. Epidemiology data on POVL from national databases, POVL in robotic surgery, and posterior reversible encephalopathy syndrome as a newer cause of POVL will also be discussed. ⋯ Strategies aimed at modifying risk factors for ischemic optic neuropathy associated with prone spinal fusion surgery that are extrinsic to the patient may decrease its incidence. Further research is needed to validate this concept.
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Donor shortage has forced transplant teams to explore new methods to increase the potential donor pool. Donation after circulatory death (DCD) has opened new perspectives and could be a valuable option to expand the brain-dead donors. The purpose of this review is to provide an overview of current practice and to identify remaining questions related to ethical and medical issues that should be further addressed in the future. ⋯ DCD donation has regained much attention during the last decade and is now part of standard clinical practice albeit this type of donation should not be regarded as an equally acceptable alternative for donation after brain death. It will be important to further explore the potential of DCD, to monitor the long-term outcomes and to further optimize the quality of these grafts. Development and implementation of uniform guidelines will be necessary to guarantee the clinical use of these donor pools.
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Curr Opin Anaesthesiol · Jun 2013
ReviewAnesthetic-related neurotoxicity in young children: an update.
This review examines the recent data, animal and human, reporting an association between early anesthetic exposure, neuronal cell death, and adverse neurocognitive and behavioral outcomes. ⋯ Although the evidence from nonhuman primates and humans is overtly concerning, it lacks clinical verification. There are, at present, no data that would dictate a change in clinical practice in the anesthetic management of infants and children.