Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewEx utero intrapartum surgery (EXIT): indications and anaesthetic management.
The ex utero intrapartum treatment (EXIT) procedure is a technique for safely managing airway obstruction at birth, in which placental support is maintained until the airway is evaluated and secured. In addition to the usual considerations of anaesthesia in obstetrics there are special considerations relating to the EXIT procedure: maintaining fetoplacental circulation by profound uterine relaxation and achieving fetal anaesthesia for airway manipulations. This chapter focuses on the key issues involved in managing this procedure: the indications, preoperative concerns, organization of a multidisciplinary team, problems of maternal and fetal anaesthesia, maintenance of the uterine relaxation and control of fetal airway.
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Anaesthetic care during thoracic surgical procedures in neonates combines components of the knowledge bases of neonatal anaesthesia with those of thoracic anaesthesia. This chapter reviews the principles of anaesthesia during thoracic surgery in neonates including the pre-operative evaluation, anaesthetic induction techniques, maintenance anaesthesia and options for post-operative analgesia. ⋯ Techniques to provide OLV in the neonate and the principles of anaesthetic care during OLV are reviewed. Finally, specific scenarios of neonatal thoracic surgery are reviewed including anaesthetic care during: (1) laryngoscopy and rigid bronchoscopy, (2) thoracoscopy, (3) repair of tracheo-oesophageal fistula, (4) resection of congenital cystic adenomatoid malformation, and (5) treatment of congenital lobar emphysema.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewRegional anaesthetic techniques for neonatal surgery: indications and selection of techniques.
The goal of neonatal care is to optimise the outcome of term and preterm infants with minimal suffering. Neonates are rare patients for the anaesthetist, therefore personal and even global experiences are limited. ⋯ With the exception of heel lancing, regional techniques are useful in all cases. However, a careful risk-benefit analysis is mandatory, especially when considering more invasive techniques such as epidural catheters.
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewAnaesthetic considerations for laparoscopic surgery in neonates and infants: a practical review.
Minimally invasive surgery is being applied to an increasing number of neonates and infants undergoing abdominal surgeries. Knowledge of specific implications, patient's health status and pathophysiological changes induced by the surgery allow the anaesthesiologist to provide safe anaesthesia to these high-risk patients. This chapter describes the specific pathophysiological effects, peri-operative management, major complications and contraindications related to endoscopic procedures.
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Because oliguria is a bad prognostic sign in patients with acute renal failure (ARF), diuretics are often used to increase urine output in patients with or at risk of ARF. From a pathophysiological point of view there are several reasons to expect that loop diuretics also could have a beneficial effect on renal function. However, clinical trials on the prophylactic use of loop diuretics rather point to a deleterious effect on parameters of kidney function. ⋯ On the other hand, such an effect cannot be excluded because the available trials lack statistical power. Possible explanations for the absence of a renoprotective effect are discussed. The evidence for a renoprotective effect of mannitol is restricted to the setting of renal transplantation.