Current opinion in anaesthesiology
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During the last few years, drug abuse has risen to the point that almost 20 million Americans are current abusers of illicit substances. These patients present to us as anesthesiologists in a variety of circumstances: in obstetrics for labor and emergencies, in trauma for emergency surgeries or life-saving (resuscitative) situations and in everyday elective surgeries. Therefore it is important for anesthesiologists to know about the most common illicit drugs being used, to know their side effects and clinical presentation if abused or intoxicated, and to know what anesthetic options would be beneficial or detrimental. ⋯ Illicit substance abuse is a major health concern in the United States. Drug use, either acute or chronic, has potentially grave consequences which include changes affecting the pulmonary, cardiovascular, nervous, renal and hepatic systems. Anesthesiologists come into contact with these patients in emergency and everyday situations. Due to the diverse clinical presentations that may arise from single substance or polysubstance abuse, anesthetic management should be tailored to each individual and universal precautions should always be followed when providing care.
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Curr Opin Anaesthesiol · Jun 2005
Current status and clinical relevance of studies of minimum local-anaesthetic concentration (MLAC).
Studies comparing the effects of epidural local anaesthetics have been limited by the lack of knowledge of their relative potencies. In 1995 the concept of the minimum local-anaesthetic concentration (MLAC) was introduced, this has been defined primarily as the median effective analgesic concentration in the first stage of labour. Pharmacologically, this model aims to determine equipotent analgesic concentrations of local anaesthetics, to compare motor effects and to evaluate the relative toxicity during labour. However, results of recent MLAC studies are not uniform and rather confusing, and thus, the basic validity of the MLAC concept for determining local-anaesthetic potency is increasingly discussed. ⋯ Relative differences in local anaesthetics' potencies derived from MLAC examinations are meaningful and correct from the pharmacological point of view, but they cannot simply be transferred to daily clinical practice. Thus, MLAC values should not be misinterpreted as these data are not suggested to be suitable to define and quantify the pharmacodynamics of local anaesthetics, nor to unequivocally predict their toxicological profile in clinically relevant concentrations.
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The purpose of this review is to discuss interesting recent developments concerning the use of halogenated agents. Now we are in a new stage of halogen use; we have become alerted to the secondary effects which although not life-threatening are potentially deleterious. ⋯ Based on this new approach, the therapeutic range of the new halogenated agents may be revisited and possibly narrowed.
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Recent experimental data from rodent studies have demonstrated accelerated neurodegeneration in rat pups exposed to commonly used anesthetic drugs. These provocative findings certainly question and undermine the safe use of anesthetic drugs, particularly in pediatric anesthesia, and have prompted many to investigate the neurotoxic effect of anesthetic drugs on the developing brain. This review will address the scientific evidence for the anesthetic-induced neurotoxicity and its applicability in humans. ⋯ Taken together, these studies question the applicability of these data to the anesthetic management of the neonate. Further investigations in this area are needed before withholding anesthetics in the anesthetic management of pediatric surgical patients.
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To review the most recent data on labor analgesia and the risk of fetal heart rate changes. ⋯ Despite the potential of neuraxial analgesia to cause fetal heart rate problems, neuraxial analgesia is the most effective and safest form of labor analgesia. Specific techniques of labor analgesia, such as high-dose spinal opioids or intrathecal clonidine, must be avoided based on the most recent evidence. Maternal and neonatal outcome is good following regional analgesia.