Current opinion in anaesthesiology
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Surgical interventions, including video-assisted thoracoscopic surgeries, are increasingly being performed in the neonatal and pediatric populations. Thoracic anesthesia in infants and children poses special challenges for the anesthesiologist. These include assessment of the patient's clinical condition, obtaining and maintaining single lung ventilation, and maintaining adequate ventilation and oxygenation while the surgery is in progress. ⋯ These techniques will provide the anesthesiologist with a number of strategies for assessing the pediatric thoracic patient and for managing pediatric single lung ventilation.
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This review presents a brief overview of the non-analgetic effects of thoracic epidural anaesthesia. It covers the cardiac, pulmonary and gastrointestinal effects of thoracic epidural anaesthesia. The results of newer studies are of particular importance regarding mortality and major morbidity after thoracic epidural anaesthesia. ⋯ Despite this controversy, the numerous positive effects and advantages of thoracic epidural anaesthesia are the reasons for its increasing popularity. However, the advantages of thoracic epidural anaesthesia must be incorporated into a multimodal treatment management aimed at improving outcomes after surgery.
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Curr Opin Anaesthesiol · Dec 2004
Alternative management techniques for the difficult airway: esophageal-tracheal Combitube.
To summarize knowledge about the esophageal-tracheal Combitube in emergency medicine and anesthesia, with special emphasis on uncommon indications. Papers published between August 2003 and July 2004 are reviewed. ⋯ The esophageal-tracheal Combitube is a useful and efficient alternative airway characterized by high success rates in emergency situations. We recommend the use of a laryngoscope for insertion and strict adherence to the manufacturer's guidelines in order to maximize success and minimize potential injury.
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The purpose of this review is to examine recent evidence for the management of the difficult airway. ⋯ This review of algorithms for management of the difficult airway strengthens several generally accepted crucial points. What is always needed is expertise, which one can only get and maintain by daily practice.
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While there are many predictors of difficult laryngoscopic intubation, they all have a low positive predictive value. Therefore, unanticipated difficult laryngoscopic intubation will likely occur in our day-to-day practice. This review discusses recent developments in alternative airway devices and techniques in addressing these difficulties. ⋯ The evidence to date does not always arm us with the ability to predict a difficult laryngoscopic intubation. Therefore, it is imperative that we equip ourselves with devices and techniques that will help us to maintain effective oxygenation and ventilation in a safe manner in the face of such failure.