Current opinion in anaesthesiology
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To provide recent evidence of safety in anesthesia and appraise the role of established tools of safety improvement in anesthesia practice. ⋯ Anesthesia is one of the safest clinical specialties and remains at the top among leaders of patient safety. This review provides evidence for the areas in which further progress can be made, and usefulness of certain tools, such as critical incident reporting, checklists, plan-do-check-act cycles and simulation, can be used for continued improvements.
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The aim of this review is to outline the priorities in the anaesthetic management of the child with facial abnormalities. It presents a practical approach to this, based on the anatomical site of the deformity and degree of mouth opening. ⋯ This is a challenging area of anaesthetic practice but the use of a structured approach, combined with supraglottic airway devices and fibre-optic and indirect laryngoscopic equipment, has allowed the safe administration of anaesthesia to almost all children with conditions resulting in facial abnormality.
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Curr Opin Anaesthesiol · Jun 2011
ReviewAnesthetic considerations for the patient undergoing therapy for advanced heart failure.
Advanced heart failure (AHF) affects a growing percentage of our population. The anesthesiologist must be cognizant of the perioperative considerations of patients undergoing state-of-the-art therapy for AHF. These therapies include classic and novel agents to improve systolic function, neurohormonal modulators, heart rhythm and synchronization management and mechanical support of the circulation. The perioperative considerations and recommendations may range from invasive hemodynamic monitoring, management of proper inotropic support to maintain left ventricular and right ventricular systolic function, isolation from electromagnetic interference in patients with rhythm management devices, maintenance of appropriate systemic and pulmonary vascular resistance, and surgical planning and anticoagulant management. ⋯ A working knowledge of AHF treatments and perioperative considerations is necessary for all anesthesiologists as more patients receiving therapy will be presenting for all types of surgical procedures.
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Curr Opin Anaesthesiol · Jun 2011
ReviewLocal anesthetic toxicity and lipid resuscitation in pregnancy.
Lipid emulsion has emerged as an effective treatment of local anesthetic-induced cardiac arrest, but its therapeutic application for the obstetric patient requires definition at present. This review discusses clinical reports, relevant laboratory studies, and future directions for the development of an optimal protocol for lipid resuscitation in pregnancy. ⋯ As the obstetric demographic becomes older and more obese, new technologies and strategies can assist in controlling maternal death and major morbidity secondary to anesthesia complications. Lipid resuscitation appears to be an effective treatment for toxicity induced by lipophilic medications and may be useful in treating systemic toxicity in the pregnant patient. Obstetric care providers should be aware of lipid resuscitation and consider its use as described by American Society of Regional Anesthesia and Pain Medicine guidelines.