Minerva anestesiologica
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A diffuse cerebral dysfunction is often present in sepsis and may ensues even before signs of other organ failure. It is better defined as ''Sepsis Associated Encephalopathy'' (SAE), in order to stress the absence of direct infection of the central nervous system. The main sign of SAE is an altered mental status. ⋯ Pathophysiology of SAE is not still completely understood, and it is probably multifactorial. Indeed, brain dysfunction in sepsis may be related to action of micro-organisms toxins, to the effects of inflammatory mediators, to metabolic alterations and to abnormalities in cerebral circulation. At this moment a specific treatment for SAE does not exist and outcome relies upon prompt and appropriate treatment of sepsis as a whole.
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This has not been a comprehensive review of problems with general anaesthesia for Caesarean section, but major issues have been considered. The old problems are still with us, but their manifestations are perhaps more subtle as anaesthesia has become more sophisticated. Most of the problems are of our own making, but hindsight is only useful if we apply it to the future. Maternal safety is best served by a continuing expansion in the use of regional anaesthesia, but we must prepare for the problems that we create by ensuring that anaesthetists are adequately trained for the occasional general anaesthetic, possibly with more help from simulation.