British journal of anaesthesia
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Neuraxial analgesic techniques are the gold standards for pain relief during labour and delivery. Despite the increased use and known benefits of neuraxial labour analgesia, there has been significant controversy regarding the impact of neuraxial analgesia on labour outcomes. Review of the evidence suggests that effective neuraxial labour analgesia does not increase the rate of Caesarean delivery, even when administered early in the course of labour; however, its use is associated with a prolonged second stage of labour. Effective second-stage analgesia might also be associated with an increased rate of instrumental vaginal delivery.
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Comparative Study
Incidence of venous gas embolism during robotic-assisted laparoscopic radical prostatectomy is lower than that during radical retropubic prostatectomy.
Robotic-assisted laparoscopic radical prostatectomy (RALRP) is gaining popularity as a less traumatic and minimally invasive alternative to open radical retropubic prostatectomy (RRP). The aim of this study was to evaluate the incidence and grade of venous gas embolism (VGE) during RALRP compared with those during RRP using transoesophageal echocardiography (TOE). ⋯ In contrast to general belief, VGE occurred less frequently during RALRP. Although the VGE in this study did not cause any cardiorespiratory instability, close monitoring for possibly fatal VGE must be considered during both types of radical prostatectomy because those who undergo radical prostatectomy frequently have cardiopulmonary co-morbidities.
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Patients are at risk for several types of lung injury in the perioperative period including atelectasis, pneumonia, pneumothorax, acute lung injury, and acute respiratory distress syndrome. Anaesthetic management can cause, exacerbate, or ameliorate these injuries. This review examines the effects of perioperative mechanical ventilation and its role in ventilator-induced lung injury. Lung protective ventilatory strategies to specific clinical situations such as cardiopulmonary bypass and one-lung ventilation along with newer novel lung protective strategies are discussed.