Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
ReviewThe anaesthetic management of caesarean section in the interventional radiology suite.
Interventional radiology has been used in the last decade for the management of major obstetric haemorrhage particularly when the placenta is pathologically adherent (accreta) or for postpartum haemorrhage when a bleeding vessel is suspected. This review describes the radiological, obstetric and anaesthetic interventions which are often carried out in the radiology suite. ⋯ This review describes the management of patients who are amenable to prophylactic or emergency radiological intervention for obstetric haemorrhage in the radiology suite. Controversy surrounds the optimum place for surgery and the most suitable mode of anaesthesia in these patients.
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Curr Opin Anaesthesiol · Aug 2011
ReviewIntraoperative management of pulmonary arterial hypertension in infants and children--corrected and republished article.
Pediatric pulmonary arterial hypertension (PAH) continues to be a considerable problem to the pediatric anesthesiologist even if its management has seen remarkable advances in recent years. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, form an appropriate anesthetic management plan. A review of some of the latest medical advances will provide the reader with a better understanding of the most current anesthetic management options. ⋯ The first important aspect of anesthetic management is to provide adequate intraoperative anesthesia and analgesia while minimizing increases in pulmonary vascular resistance and myocardial. Depending on the procedure, these goals can be met with the administration of either sedation/analgesia or general anesthesia together with new drugs for PAH treatment in association with a high potential for adverse events.
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Curr Opin Anaesthesiol · Aug 2011
Anaesthesia for magnetic resonance imaging and positron emission tomography.
This article reviews the important aspects of managing patients undergoing anaesthesia and monitoring for MRI and PET. ⋯ The availability of high-field MRI and other complex imaging studies, like PET is increasing. This requires that anaesthesiologists and critical care physicians understand the principles, safety concerns and appropriate management of patients undergoing imaging within such environments.
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Hypoxia represents one of the strongest transcriptional stimuli known to us. In most cases, hypoxia-induced changes in gene expression are directed towards adapting tissues to conditions of limited oxygen availability. ⋯ In the present review, we discuss the mechanisms of transcriptional adaptation to hypoxia and provide evidence supporting the hypothesis that targeting hypoxia-induced inflammation can represent novel pharmacologic strategies to improve perioperative outcomes. Currently, such strategies are being explored at an experimental level, but we hope that some of these targets can be translated into perioperative patient care within the next decade.