Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2019
ReviewAnesthesia for predelivery procedures: ex-utero intrapartum treatment/intrauterine transfusion/surgery of the fetus.
The aim of this study was to review the current literature on anesthesia for predelivery procedures and to summarize recent findings on anesthesiological methods used. ⋯ Predelivery procedures require a differentiated anesthesia approach depending on the invasiveness of the intervention. Anesthesia ranges from monitored care to neuraxial anesthesia and general anesthesia. Depending on the procedure uterine relaxation and fetal immobilization are crucial for technical success. Interdisciplinary consultation optimizes the anesthesia plan for complex procedures.
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Prediction of postoperative pulmonary complications (PPCs) enables individually applied preventive measures and maybe even early treatment if a PPC eventually starts to develop. The purpose of this review is to describe crucial steps in the development and validation of prediction models, examine these steps in the current literature and describe what the future holds for PPC prediction. ⋯ Many predictive models for PPCs have been reported on. Development of more robust PPC prediction models could be supported by machine learning.
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Curr Opin Anaesthesiol · Jun 2019
ReviewPostpartum hemorrhage revisited: new challenges and solutions.
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality in the United States, and worldwide. Recognition of PPH is challenging, but once hemorrhage is recognized, management needs to focus on achieving adequate uterine tone and maintaining maternal hemodynamic stability. There have been several advances in the management of postpartum hemorrhage, many of which can be implemented at the labor and delivery unit level. ⋯ Although postpartum hemorrhage itself may not be preventable, early identification of blood loss, and mobilization of resources may prevent adverse outcomes. Multidisciplinary planning at the system level, ensuring that hemorrhage protocols exist, as well as for management of high-risk patients is important for improving patient outcomes.
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Curr Opin Anaesthesiol · Jun 2019
ReviewRecent advances in diabetes treatments and their perioperative implications.
The implications for perioperative management of new oral antihyperglycemic medications and new insulin treatment technologies are reviewed. ⋯ Sulfonylureas and SGLT2i should be ceased before moderate or major surgery. Other oral antihyperglycemic therapies may be continued or ceased. Complex patients and/or new therapies require specialized multidisciplinary management.
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Curr Opin Anaesthesiol · Jun 2019
ReviewClonidine in pediatric anesthesia: the new panacea or a drug still looking for an indication?
Clonidine, an α2-receptor agonist is a widely used drug in pediatrics with a large scope of indications ranging from prevention of postoperative emergence agitation, analgesia, anxiolysis, sedation, weaning to shivering. In the era of 'opioid-free' medicine with much attention be directed toward increasing problems with opioid use, clonidine due to its global availability, low cost and safety profile has become an even more interesting option. ⋯ Clonidine appears a safe and beneficial drug with moderate to high-quality evidence supporting its use in pediatric anesthesia. However, for some indications and populations such as children younger than 12 months old and those with hemodynamic instability, there is an urgent need for high-quality trials.