Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Review
The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review.
To review current knowledge concerning the use of magnesium in anesthesiology, intensive care and emergency medicine. ⋯ Magnesium has many known indications in anesthesiology and intensive care, and others have been suggested by recent publications. Because of its interactions with drugs used in anesthesia, anesthesiologists and intensive care specialists need to have a clear understanding of the role of this important cation.
-
To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD). ⋯ The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing.
-
This review on ultrarapid detoxification examines the pharmacology, techniques, and efficacy of this potentially promising technique and contrasts it with conventional treatment modalities. ⋯ Ultrarapid opiate detoxification, performed under the proper circumstances, is associated with few adverse events and is relatively comfortable for patients who seek treatment for their addition.
-
The first criteria for the determination of brain death were developed in 1968 in part to address concerns that had arisen with the retrieval of organs for transplantation. Despite over 30 years of application, some professional and public doubt persists over the validity of the theoretical construct underlying this method of determining death. Our review will address historical perspectives on the development of brain death criteria, and inconsistencies in current clinical criteria. ⋯ Organ transplantation is premised on professional and public acceptance that the donor is dead. Given that the criteria for brain death or their application remain variable, we suggest that it is reasonable to consider a national consensus to address these inconsistencies. Alternatively, the standard use of confirmatory radiographic testing prior to the retrieval of organs from donors who meet clinical brain death criteria should be considered to provide conclusive evidence of permanent and irreversible loss of brain function.