Current opinion in anaesthesiology
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To describe the recent advances in labor epidural analgesia, which may have an impact on maternal ambulation during labor. ⋯ Since the earliest 'walking epidural' was described in the early 1990s, there has been much research into finding the ideal regional technique for labor analgesia that provides excellent analgesia with high maternal satisfaction scores while having little adverse effect on obstetric outcome. This review attempts to map the journey of the 'walking epidural' from its earliest form to its more recognizable modern day appearance.
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Preoperative anesthesia consultation before major surgery presents opportunities to better document comorbid illness, optimize medical conditions, facilitate referrals to specialists, order specialized investigations, initiate interventions to decrease risk, discuss aspects of perioperative care, and arrange appropriate postoperative care. The goal of this review is to discuss the implications of recent studies that have evaluated the processes-of-care and outcomes related to preoperative anesthesia consultation. ⋯ Preoperative anesthesia consultations have become increasingly common and have shown some clear beneficial effects on perioperative care and outcomes. Further research remains needed to identify efficacious interventions for reducing perioperative risk, measure the prognostic value of specialized preoperative tests, and compare the safety of different models for performing preoperative consultations.
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Distress in children during hospitalization is increasingly seen as unacceptable and preventable. Surgery and anaesthesia are distressing events for children with maximum stress at induction of anaesthesia. This review aims to report the recent research relevant to reducing this distress in children with a focus on the preoperative period and the impact of this on behaviour at induction and long-term postoperatively. ⋯ New measures of anxiety will facilitate better evaluation of children clinically and better future research. The role of α2-adrenergic agonists in premedication remains unclear. There is still little research, which examines outcomes for techniques for minimizing distress, which are based on specific assessment of the child and family.
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Curr Opin Anaesthesiol · Jun 2011
ReviewOxytocin for labour and caesarean delivery: implications for the anaesthesiologist.
The implications of the obstetric use of oxytocin for obstetric anaesthesia practice are summarised. The review focuses on recent research on the uterotonic effects of oxytocin for prophylaxis and management of uterine atony during caesarean delivery. ⋯ Oxytocin remains the first-line uterotonic after vaginal and caesarean delivery. Recent research elucidates the therapeutic range of oxytocin during caesarean delivery, as well as receptor desensitization. Evidenced-based protocols for the prevention and treatment of uterine atony during caesarean delivery are recommended.
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Curr Opin Anaesthesiol · Jun 2011
ReviewMaternal haemodynamic changes during spinal anaesthesia for caesarean section.
Maternal haemodynamic changes during spinal anaesthesia for caesarean section have traditionally been evaluated by noninvasive blood pressure and heart rate. Recent publications have addressed the importance of cardiac output measurement in the assessment of the maternal circulation. In this review, a physiological approach is suggested for the prevention and treatment of haemodynamic instability during caesarean section in healthy women and in those with preeclampsia or cardiac disease. ⋯ The most frequent response to spinal anaesthesia for elective caesarean section is a marked decrease in systemic vascular resistance and partial compensation from increased stroke volume and heart rate. Early administration of phenylephrine by bolus or continuous infusion is indicated in most cases. Recent work has expanded our knowledge of the therapeutic range of phenylephrine and indicates that the heart rate response to vasopressors is a good surrogate marker for cardiac output. Further research should examine haemodynamic changes during spinal anaesthesia in high-risk pregnant women with early onset preeclampsia or cardiac disease.