Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2009
ReviewPresent and emerging strategies for reducing anesthesia-related maternal morbidity and mortality.
As the demographic of pregnant women continues to change, anesthesiologists will need to continue to find new ways to prevent morbidity and mortality. In this article several new and emerging strategies to meet this challenge are discussed. ⋯ Over the past 50 years, the field of anesthesiology has reduced the rates of anesthesia-related maternal mortality and major morbidity considerably. As the obstetric demographic becomes older and more obese, new technologies and strategies can assist in keeping maternal death and major morbidity vanishingly rare.
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Curr Opin Anaesthesiol · Jun 2009
ReviewEffect of head posture on pediatric oropharyngeal structures: implications for airway management in infants and children.
Although head and neck posture has direct effects on the upper airway in infants and children, many of these effects remain unclear or not well established. As airway patency and airway access are critical in sedated and/or unconscious children, recent developments in this area should be made known to pediatric anesthesiologists, intensive care physicians and other emergency caregivers. ⋯ The site of obstruction of the airway in sedated children in different postures is now more clear. Implications of head flexion and extension in intubated children have been extensively studied, and clinical consequences have been detailed. Due to large interindividual anatomic variability, depth marks set on the tubes by their manufacturers and guidelines regarding calculations of insertion depth should be made with caution in infants and neonates. Despite several studies, there is still little scientific evidence regarding proper head posture for laryngoscopy and intubation.
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Obese, morbidly obese and ultra-obese patients have multiple surgical procedures. Although they can have an acute abdomen, obstetric procedures, trauma-related procedures and many others, morbidly obese patients are most consistently cared for in the bariatric surgery operating room. The lessons from that group of patients can, could and, usually, should be applied in all patients who are morbidly obese and present for anesthetic care. ⋯ The number of patients with obesity and morbid obesity continues to increase. Following certain guidelines will ease the management and improve outcomes of the morbidly obese patient presenting for any surgery.
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Curr Opin Anaesthesiol · Jun 2009
ReviewIntraoperative management of pulmonary arterial hypertension in infants and children.
Pediatric pulmonary arterial hypertension (PAH) continues to be a considerable problem to the pediatric anesthesiologist, even if its management has seen remarkable advances in the recent year. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, and 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 function. 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 · Jun 2009
ReviewAnaesthetic issues in women undergoing gynaecological cytoreductive surgery.
Increasing numbers of women with ovarian cancer are undergoing cytoreductive surgery in reference centres. This review looks at this disease in these women and the different aspects of perioperative clinical management of these patients by the anaesthetic team: preoperative screening, anaesthetic techniques, fluid or blood management or both and prevention and treatment of important complications. ⋯ Anaesthesia is more than 'keeping asleep'. Anaesthesiologists have an enormous responsibility in the preoperative, peroperative, and postoperative period for patients undergoing gynaecological cytoreductive surgery.