Current opinion in anaesthesiology
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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.
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The regimen of thiopental, succinylcholine (SCh) and unsupplemented nitrous oxide/oxygen for Caesarean section was first introduced 50 years ago. This review examines which elements have endured, what has changed, and how practice might alter in the very near future. ⋯ It is now feasible that SCh might be replaced with a high-dose rocuronium-sugammadex combination.
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Curr Opin Anaesthesiol · Jun 2009
ReviewScreening for obstructive sleep apnea before surgery: why is it important?
The purpose of this article is to review the screening tools available in the preoperative clinic for patients at risk of obstructive sleep apnea. ⋯ The STOP questionnaire is short and can be easily incorporated into routine screening of general or surgical patients.
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This review examines the literature on the ability of an epidural test dose to detect intravascular or intrathecal epidural catheter misplacement in the obstetric patient. ⋯ Gentle aspiration followed by an appropriate test dose, in epidural anesthesia for cesarean section, and careful observation of the patients in epidural labor analgesia increase the likelihood that an incorrectly placed catheter will be detected and that a harmful reaction to local anesthetics will be avoided.
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Curr Opin Anaesthesiol · Jun 2009
ReviewAnaesthesia and Parkinson's disease: how to manage with new therapies?
Parkinson's disease is the second most prevalent neurodegenerative disease and presents a particular anaesthetic challenge. The clinical features are described in detail, and recent advances in medical management and neurosurgical treatment options are highlighted. ⋯ DBS is an attractive option for severely disabled patients with Parkinson's disease who pose a particular anaesthetic challenge.