Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2012
ReviewSociety for Ambulatory Anesthesia consensus statement on preoperative selection of adult patients with obstructive sleep apnea scheduled for ambulatory surgery.
The suitability of ambulatory surgery for a patient with obstructive sleep apnea (OSA) remains controversial because of concerns of increased perioperative complications including postdischarge death. Therefore, a Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for ambulatory surgery. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ⋯ How does this guideline differ from existing guidelines? Unlike the ASA guidelines, this consensus statement recommends the use of the STOP-Bang criteria for preoperative OSA screening and considers patients' comorbid conditions in the patient selection process. Also, current literature does not support the ASA recommendations that upper abdominal procedures are not appropriate for ambulatory surgery. Why does this guideline differ from existing guidelines? This consensus statement differs from existing ASA guidelines because of the availability of new evidence.
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Anesthesia and analgesia · Nov 2012
ReviewCore review: physician-performed ultrasound: the time has come for routine use in acute care medicine.
The use of ultrasound in the acute care specialties of anesthesiology, intensive care, emergency medicine, and surgery has evolved from discrete, office-based echocardiographic examinations to the real-time or point-of-care clinical assessment and interventions. "Goal-focused" transthoracic echocardiography is a limited scope (as compared with comprehensive examination) echocardiographic examination, performed by the treating clinician in acute care medical practice, and is aimed at addressing specific clinical concerns. In the future, the practice of surface ultrasound will be integrated into the everyday clinical practice as ultrasound-assisted examination and ultrasound-guided procedures. ⋯ The key to making ultrasound available to every physician is through education programs designed to facilitate uptake, rather than to prevent access to this technology and education by specialist craft groups. There is evidence that diagnosis is improved with ultrasound examination, yet data showing change in management and improvement in patient outcome are few and an important area for future research.
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Anesthesia and analgesia · Nov 2012
ReviewOff-label use of medications in children undergoing sedation and anesthesia.
Many drugs used for anesthesia and analgesia in children are administered "off-label." We undertook an audit of drugs commonly used for pediatric anesthesia to determine which drugs have United States Food and Drug Administration (FDA) labeling for pediatric use, which drugs are age-restricted, and which have no labeling for pediatric use. ⋯ Many drugs used for children during anesthesia continue to lack FDA labeling for pediatric use. Off-label use of these drugs is an accepted practice that is considered superior to the alternative of withholding needed medications. Studies are still needed to determine the safety and efficacy of drugs that lack FDA labeling for this vulnerable patient population.
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Anesthesia and analgesia · Nov 2012
ReviewGeneral anesthesia: a gateway to modulate synapse formation and neural plasticity?
Appropriate balance between excitatory and inhibitory neural activity patterns is of utmost importance in the maintenance of neuronal homeostasis. General anesthetic-induced pharmacological interference with this equilibrium results not only in a temporary loss of consciousness but can also initiate long-term changes in brain function. Although these alterations were initially considered deleterious, recent observations suggest that at least under some specific conditions, they may eventually improve neural function. ⋯ Recent series of observations suggesting a developmental stage-dependent impact of these drugs on synaptogenesis will then be summarized together with currently known molecular mechanisms underlying these effects. Particular emphasis will be placed on how anesthetic drugs modulate neural plasticity in the adult brain and how this may improve neural function under some pathological states. The ensemble of these new observations strongly suggests that general anesthetics should not merely be considered toxic drugs but rather acknowledged as robust, context-dependent modulators of neural plasticity.