Current opinion in anaesthesiology
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General anesthetics and sedatives are used in millions of children every year to facilitate surgical procedures, imaging studies, and sedation in operating rooms, radiology suites, emergency departments, and ICUs. Mounting evidence from animal studies suggests that prolonged exposure to these compounds may induce widespread neuronal cell death and neurological sequelae, seriously questioning the safety of pediatric anesthesia. This review presents recent developments in this rapidly emerging field. ⋯ Neurodegeneration following exposure to anesthetics and sedatives has been clearly established in developing animals. However, while some of the biochemical pathways have been revealed, the phenomenon's particular molecular mechanisms remain unclear. As the phenomenon is difficult to study in humans, clinical evidence is still scarce and amounts to associative and not causal relationships. Owing to the lack of alternative anesthetics, further animal studies into the mechanism as well as clinical studies defining human susceptibility are both urgently needed.
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We describe the different possible anaesthetic techniques for an emergency caesarean section. To choose the right method of anaesthesia may have major implications for mother, child and all involved personnel. The major controversy is whether one have other or better alternatives or both than general anaesthesia, with a rapid sequence induction technique, when the foetus is compromised. ⋯ Regional anaesthesia techniques such as a single-shot spinal or a top-up of a well functioning labour epidural analgesia are good alternatives to general anaesthesia in an emergency caesarean setting.
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Curr Opin Anaesthesiol · Jun 2009
ReviewSpontaneous respiration during intravenous anesthesia in children.
Maintaining spontaneous respiration during intravenous anesthesia for investigative and surgical procedures may avoid the need for airway instrumentation and reduce the risk of desaturation. In addition, when performing airway endoscopic procedures in children, maintaining spontaneous respiration while using intravenous anesthesia can reduce the need for endotracheal intubation. This facilitates improved access to the smaller airway, allows assessment of the dynamic function of the airway, and reduces exposure of personnel to inhaled anesthetic agents. ⋯ Spontaneous respiration can be maintained when anesthetizing children using intravenous anesthesia.
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Curr Opin Anaesthesiol · Jun 2009
ReviewChanging trends in paediatric regional anaesthetic practice in recent years.
Regional anaesthesia has come to a substantial position in paediatric anaesthesia. Time has now come to assess what has reached significant acceptance in daily practice and try to clear possible ways up for the next steps to come. ⋯ Lessons can be drawn from epidemiologic data now available and possible ways for changes in a near future can be anticipated. Ultrasonology brings clear advantages in abdominal wall blocks. Its use in place of nerve stimulation is claimed forcefully but not yet widely used for the blocks of the limbs in children. This switch requires profound changes in the practice of regional anaesthesia which will probably not take place immediately. Blocks of the face appear innovating and promising, according to recent literature.
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To evaluate the effect of epidural analgesia on breastfeeding. ⋯ There is no good evidence that epidural analgesia causes reduced breastfeeding success. Good lactation support is critical.