Current opinion in anaesthesiology
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To knock down the following myths: obesity in paediatric patients is rare and mainly a North-American problem; obesity in childhood has no long-term harmful effects. To sensitize the anaesthesiologists to a problem seldom addressed in the anaesthetic literature. ⋯ The early manifestations of the comorbidities associated with obesity in adults are already present in overweight and obese children and should be addressed for their safe anaesthetic management. Perioperative respiratory events seem more frequent in overweight and obese patients.
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Curr Opin Anaesthesiol · Jun 2008
ReviewLow-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension.
The present review evaluates the evidence available in the literature to see whether low-dose spinal anaesthesia for Caesarean section is effective in preventing maternal hypotension while at the same time guaranteeing effective anaesthetic conditions. ⋯ Low-dose spinal anaesthesia as part of a combined spinal-epidural technique is a valuable method in improving maternal and fetal outcome during anaesthesia for operative delivery.
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The control of pain after scoliosis surgery is a real challenge for the anesthesiologist. The first reason is that major spine surgery for correction of scoliosis deformation causes severe postoperative pain, and second that patients undergoing these operations are most often children or adolescents who are known to suffer from increased pain sensation compared with adults. ⋯ Significant improvements have been made in the control of postoperative pain after correction of scoliosis deformation in recent years. The introduction of epidural analgesia has cleared the way for better analgesic techniques in this surgical context. Properly performed and assessed, the addition of epidural analgesia after scoliosis surgery is a safe and effective form of analgesia and the benefits far outweigh the risks.
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The present review describes new trends and ongoing controversies in the anesthetic care of liver transplant recipients. ⋯ Anesthetic management still varies widely between liver transplant centers with little data to indicate best practice. Future research should focus on fluid replacement, prevention and treatment of coagulopathy, care of the acutely ill patient and the safety and benefits of early extubation.
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Curr Opin Anaesthesiol · Jun 2008
ReviewInfection associated with central venous or epidural catheters: how to reduce it?
Central venous catheters are a leading source of nosocomial bloodstream infection with an estimated 10% mortality. Infection associated with epidural catheterization is an uncommon but devastating complication. Diagnosis of spinal epidural abscess requires a high index of suspicion and imaging techniques such as MRI. Early diagnosis and treatment will minimize permanent damage, but primary prevention should be the aim, which depends on proper patient evaluation and use of full aseptic precautions. ⋯ Healthcare worker education and training are essential to create standardization of aseptic care. Continuous surveillance is necessary for identifying lapses in infection-control practices.