ARDS is often associated with multiple organ dysfunction and carries a high mortality, morbidity and financial cost.
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Due to its prevalence in the critical care patient population, it is important for physicians to understand some principles of management that may help reduce the mortality and morbidity of the syndrome. Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity. Oxytocic drugs are the main stay in prevention as well as treatment. Oxytocin remains the drug of choice.
Deaths of babies in the first 28 days of life in resource-limited countries can be significantly reduced with a small number of low-tech interventions. This article summarises the core equipment and skills needed for the resuscitation of newborns where equipment is limited and skilled paediatric support is not available. Open this file File size: 1. Physiological changes in the parturient occur due to the needs of the developing foetus.
Understanding these changes is important when administering anaesthesia to the obstetric patient. Additionally, understanding the physiological effects in the foetus allows for appropriate intrauterine monitoring and expedient delivery if there are signs of foetal hypoxia. Sepsis remains one of the four main causes of maternal mortality. Open this file File size: 0MB.
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Trauma during pregnancy is the leading non-obstetrical cause of maternal death and remains the most common cause of foetal demise. Obesity is one of the greatest public health challenges of the 21st century. Obesity during pregnancy puts the mother, fetus and neonate at higher risk of morbidity and mortality during the antenatal, intrapartum and postnatal periods.
Pre-eclampsia causes significant morbidity and mortality to both mother and foetus worldwide, the major causes being delayed diagnosis and poor management. Identifying the parturient at risk of developing pre-eclampsia is paramount and optimising this patient cohort is key.
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Early management of pre-eclampsia favours a better outcome with magnesium sulphate and anti-hypertensive medications being the mainstay of treatment. The cause of maternal collapse and cardiorespiratory arrest is not always immediately apparent.
Key modifications to these algorithms are required in pregnancy. These include early intubation and the use of lateral tilt or uterine displacement. The health of women correlates strongly with the social and economic well-being of a community. However, pain during childbirth is undertreated in variable resource environments Epidurals provide safe and efficient provision of anesthesia for unplanned or emergent cesarean delivery.
This article focuses on establishing an epidural service to provide labour analgesia and anesthesia for nonscheduled cesarean delivery. Anatomical factors such as previous spinal surgery can affect placement and subsequent epidural failure. Labour epidurals provide safe, effective analgesia with minimal side effects to mother and fetus. Knowledge of anatomy and pain pathways are key to providing epidural analgesia to labouring parturients. Consent can be challenging during active labour. Total spinal or a high neuraxial blockade is a recognised complication of central neuraxial techniques.
A high number of incidents of a high neuraxial block are being reported in obstetrics following the increased use of neuraxial anaesthesia. Caesarean section is the most frequently performed obstetric surgical procedure, and spinal anaesthesia is a common anaesthetic technique used across the world. It produces rapid, dense, predictable block, is relatively easy to perform with a definite end point and has a very high success rate.
General anaesthesia for caesarean section entails the risk of life-threatening complications such as difficult airway management and aspiration pneumonia, and it is therefore recommended that it be avoided whenever possible in favour of neuraxial anaesthesia. Obstetric airway management has long been associated with an increased risk of failed tracheal intubation and airway-related morbidity and mortality. However, there is little evidence that failed intubation rates have fallen despite recent advances in airway equipment and techniques.
Members of WFSA's Obstetric anaesthesia committee and experts in obstetrics anaesthesia from around the globe, offers an important contribution to improve patient care and access to safe peripartum care. A significant number of women undergo anesthesia and surgery during pregnancy for procedures unrelated to delivery. In order to provide safe anaesthesia for mother and fetus, it is essential for the anesthetist to have thorough understanding of the physiological and pharmacological changes that characterize the three trimesters of pregnancy.
A multidisciplinary team approach is highly recommended to ensure an adequate standard of care.
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The tutorial aims to raise awareness of irrigation fluids that are commonly come across in operations. It covers the pharmacological properties of irrigation fluid, potential complications associated with its intraoperative use and measures to limit negative outcomes. This tutorial provides a review of the ultrasound guided infraclavicular brachial plexus block including clinical indications and contraindications, sonoanatomy, and helpful tips on block performance.
This tutorial reviews the anaesthetic considerations for urological robotic procedures, covering the pre, intra and post operative stages. Tramadol and tapentadol are two related molecules that are being used to treat acute pain. In this tutorial we discuss the basic pharmacology, safety and efficacy of both medications. As well, indications for use, safety recommendations and abuse potential are discussed. This tutorial reviews the clinical uses of tranexamic acid, its mechanism of action and pharmacokinetics, contraindications and side effects.
Non steroidal inflammatory drugs are an effective simple analgesic medication that all anaesthetists should be familiar with. Although highly effective they have a complex mode of action and many possible side effects and drug interactions. It is vital to know the basic pharmacology when prescribing these medications to avoid any complications. Este tutorial incluye recomendaciones nuevas relacionadas con el bloqueo neuroaxial. Ischaemic stroke is a life threatening and disabling condition.
The treatment options have previously included antiplatelet agents, modification of risk factors, thrombolysis and rehabilitation. Mechanical thrombectomy is now considered a gold standard treatment. Its indications are widening with implications for healthcare management and for anaesthetists providing care for these patients. This tutorial is a brief overview of the various currently established regional anaesthetic techniques to provide analgesia following breast surgery. Diabetes mellitus is the most common endocrine disorder in children.
The peri-operative period can disrupt glucose control resulting in hypo and hyperglycaemia. Multi-disciplinary management is important to optimise glucose control and minimise complications. Insulin pump therapy is increasing in children and anaesthetists should be familiar with management. A review of the anatomy of the sciatic nerve and its branches, and the indications, contraindications and technique for ultrasound guided popliteal block. This tutorial reviews the anatomy of the brachial plexus and adjacent structures relevant to the interscalene block.
It also discusses of the indications, contraindications, side effects and complications of the interscalene block and a step-by-step description of the ultrasound guided interscalene nerve block technique. Open this file File size: 0MB Take the quiz. This tutorial aims to describe the available national society guidelines on managing pediatric airways, and to compare the difficult airway trolleys of two different institutions from different resource settings. Este tutorial apresenta o manejo de anestesia para TORS. Pre-hospital emergency anaesthesia refers to induction of anaesthesia and securing the airway in the pre-hospital environment.
It is high risk due to patient factors and the pre-hospital environment. Many factors should be addressed to minimise risks. This tutorial explores some of these factors and discusses recent changes in practice.
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In this narrative review, the authors discuss two commonly used long-term venous access devices: implantable ports and tunnelled catheters. This article explores in detail the The Vital Anaesthesia Simulation Training VAST course, which was developed for anaesthesia providers and is a collaborative project between partners in Rwanda and Canada.
This article explores the management of malignant hyperthermia, a rare inherited disorder that develops following exposure to volatile anaesthetic agents and depolarising muscle relaxants.
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What is needed next for global surgery, obstetrics and anaesthesia is not a simple linear process; rather, it is a cycle of three co-dependent elements: data, NSOAPs and funding. Patient safety is normally defined as omission of harm during medical care in hospital.
Relative to the global challenge, a wider scope is needed, including the primary care sector and coverage of care, or lack thereof, as well as quality of care. Surgical and anaesthesia care are undeniably critical to strengthening healthcare systems worldwide and they are steadily gaining support from the World Health Organization WHO. This article explores a human resource shortage compounded by the fact that the skills, competencies and clinical experience of providers are often poorly suited to the health needs of the populations being served.