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Preoperative iron therapy: Where are we?
Best Pract Res Clin Anaesthesiol
December 2023
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Preoperative anemia affects one-third of patients undergoing major surgery and is associated with worse perioperative and postoperative outcomes; including length of hospital stay, allogeneic blood transfusion, morbidity, and mortality. Iron deficiency is the most common cause of anemia, and associative data suggests that preoperative correction of iron deficiency anemia could improve postoperative patient outcomes. However, data from randomized controlled trials (RCTs) do not appear to support the routine use of iron therapy to treat preoperative anemia.
View Article and Find Full Text PDFHow low can you go: Restrictive transfusion strategies in major surgery and physiological triggers.
Best Pract Res Clin Anaesthesiol
December 2023
Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address:
Anemia and red blood cell transfusion are associated with adverse outcomes. Large randomized trials have demonstrated that restrictive transfusion strategies can safely reduce patient exposure to transfusion, forming a foundational pillar of patient blood management. The restrictive transfusion thresholds in these trials ranged from 7 to 8 g/dL for different populations and this variability is reflected in recent guideline recommendations for transfusion triggers.
View Article and Find Full Text PDFExtracorporeal membrane oxygenation and pregnancy.
Best Pract Res Clin Anaesthesiol
September 2024
Department of Anaesthesiology, University Hospitals Leuven (BE), Department of Cardiovascular Sciences, KU Leuven (BE), Herestraat 49, B-3000, Leuven, Belgium.
Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods.
View Article and Find Full Text PDFPostdural puncture headache: Beyond the evidence.
Best Pract Res Clin Anaesthesiol
September 2024
Yale Medicine/Yale New Haven Health System, USA. Electronic address:
Despite advances in procedural techniques and equipment, postdural puncture headache (PDPH) remains a serious complication of labour epidural analgesia after accidental dural puncture (ADP). Often considered a temporary inconvenience, PDPH can be debilitating in the short term. It can also be associated with chronic manifestations and serious complications.
View Article and Find Full Text PDFNon-neuraxial labour analgesia.
Best Pract Res Clin Anaesthesiol
September 2024
Department of Anaesthesia, Ulster Hospital, Belfast, Northern Ireland.
Epidural analgesia is considered the gold standard for labour pain but may not be an option for all parturients due to patient choice or medical contraindication. Non-neuraxial alternatives for labour analgesia have been extensively studied and include both pharmacological and non-pharmacological options. Pharmacological options include the use of opioids and inhalational agents while non-pharmacological options range from non-invasive methods such as continuous labour support to techniques such as sterile water injection.
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