Current opinion in anaesthesiology
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This review aims to summarize results of recently published studies concerning clonidine application in paediatric anaesthesia, to analyse trends in these studies, and to discuss perspectives of the perioperative use of clonidine for children. ⋯ Clonidine may be less favored than midazolam as premedication for children because of inferior clonidine-induced sedation. Additional comparative studies are required, however, to confirm this finding. On the other hand, clonidine-induced analgesia may well be useful and find wide application in paediatric anaesthesia. Prospective multicentre trials using a larger number of patients will be needed to verify the usefulness of caudal clonidine for postoperative pain relief. Prophylactic use of clonidine against sevoflurane-induced agitation may represent a new and promising application. Assessment of the efficacy of clonidine in potentiating regional anaesthesia/analgesia by local anaesthetics in children also needs more investigation. Moreover, it may be worthwhile to try new successful applications demonstrated in adults for paediatric anaesthesia.
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In neonates, epidural catheters inserted at the sacral hiatus can easily be advanced to a lumbar or thoracic level. These 'caudal catheters' are popular because they allow the neonate to benefit from epidural analgesia without the concerns of spinal cord injury potentially associated with primary thoracic placement in an asleep neonate. This review looks at use and benefits, and risks and complications of caudal epidural catheters in neonates. ⋯ Epidural anesthesia and analgesia for neonates should be performed and managed by pediatric anesthesiologists. Potential risks and complications must be appreciated and all steps to maximize safety of the technique must be taken. In particular, close postoperative observation and pain service management are indispensable. Future research should investigate the risks of caudal and segmentally placed catheters in neonates, study the role of epidural analgesia in outcome improvement for neonates, and guide us to safer use of local anesthetics suitable for neonates with their pharmacologic immaturity.
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Multiple sclerosis remains prevalent among young women in the United States of America. It is a disease of the central nervous system that possesses many anesthetic implications. Anesthesia providers need to understand this disorder and its multiple anesthetic ramifications. ⋯ In summary, our aim is to provide an updated view of multiple sclerosis from the perspective of perioperative care, emphasizing interactions between the disease, surgery and anesthesia.
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During the last 2 years, some interesting new devices have been made available to improve airway management in children and infants, and several studies have advanced our understanding concerning risks and benefits of the current practice in the field. Certain risk factors for airway related problems during anaesthesia in children having a cold have been identified, and new aspects of the controversy concerning the use of cuffed endotracheal tubes in children presented. Novel video-assisted systems have been introduced for the management of the difficult airway in paediatric patients, and new applications for well known devices have been suggested, such as the laryngeal mask airway serving as guidance for fibreoptic intubation. ⋯ A. Group, USA). Furthermore, the following review presents new data about the use of the cuffed oropharyngeal airway, the laryngeal tube, and the Arndt bronchus blocker in paediatric patients.
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Diabetes mellitus has diverse effects on all organ systems of the body. Insulin physiology and metabolic control are far more complex than previously thought. Research continues to reveal more information about the central role of insulin in metabolism. The treatment of hypertension and nephropathy as well as hyperglycemia in patients with diabetes has emerged as being critical for prevention of long-term diabetic complications. The issue of primary importance to the anesthesiologist is whether strict glycemic and hemodynamic control during the perioperative period affect outcome. ⋯ Tight long-term control of glucose and blood pressure improve outcome in patients with diabetes. The same philosophy of management is being applied to the perioperative period. Routine measurement of intraoperative blood glucose levels and appropriate insulin administration are now standard practice, but the ideal regimen for insulin administration remains to be determined.