Current opinion in anaesthesiology
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Taking in charge severely ill patients in the intensive care environment to manage complex procedures is a performance requiring highly specific knowledge. Close collaboration between anaesthetists and intensive care specialists is likely to improve the safety and quality of medical care. ⋯ New modes of administration and monitoring intravenous anaesthesia have been developed, with potential application in the intensive care unit. These include the use of target-controlled administration of intravenous drugs, and of electroencephalographic signals to monitor the level of sedation.
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Curr Opin Anaesthesiol · Jun 2001
New insights into regional anesthesia in children: new techniques and new indications.
The applications and indications for pediatric regional anesthesia continue to increase. Several recent advances have occurred in the understanding of this technology in children, including improved techniques, alternative drug combinations, as well as prospective investigations to understand the nature and incidence of adverse effects associated with these techniques when used in pediatric patients. The following article will review recent information from the literature concerning various regional anesthetic techniques in children, including caudal epidural block, lumbar and thoracic epidural anesthesia, and peripheral nerve blockade.
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Over the years paediatric regional anaesthesia has gained a worldwide consensus, and it can now be considered a significant part of perioperative pain control in children. As in many fields, with the use of drugs administered epidurally there is a fundamental need for safety and efficacy. ⋯ To prolong their analgesic duration, many adjuvants can be used, and clonidine and ketamine are probably the best solution. This review summarizes the most recent data on these drugs and their use in children.
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The present review addresses common and rare, but potentially severe complications of obstetric anaesthesia. Although several recent randomized and controlled studies on the prevention of spinal hypotension have been reported, the incidence of neurological complications caused by neuraxial blocks is estimated primarily from the results of retrospective investigations and case reports. In order to avoid potential risks in obstetrics, however, vigilance and close monitoring of the patient are critical. The adoption of published recommendations (e.g. those regarding regional techniques and coagulopathy, and difficult airway management) may help to improve the outcome for mother and child.
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A patent, unobstructed airway is fundamental in the care of the trauma patient, and is most often obtained by placing a cuffed tube in the trachea. The presence of shock, respiratory distress, a full stomach, maxillofacial trauma, neck hematoma, laryngeal disruption, cervical spine instability, and head injury all combine to increase tracheal intubation difficulty in the trauma patient. ⋯ The management of the failed airway includes calling for assistance, optimal two-person bag-mask ventilation, and the use of the laryngeal mask airway, Combitube, or surgical airway. The simulation of airway management using realistic simulator tools (e.g. full-scale simulators, virtual reality airway simulators) is a promising modality for teaching physicians and advanced life support personnel emergency airway management skills.