Current opinion in anaesthesiology
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Cancer is beginning to outpace cardiovascular disease as the primary cause of death in the developed world. A majority of cancer patients will require anaesthesia either for primary debulking tumour removal or to treat an adverse consequence of the malignant process or its treatment. Therefore we outline here the pathophysiology of cancer, generalized metastatic disease and systemic chemotherapy and radiotherapy on major organ systems. The anaesthetic considerations for optimum perioperative management of cancer patients are discussed, and the possibility of anaesthetic technique at primary cancer surgery affecting long-term cancer outcome is mentioned. ⋯ Optimum perioperative patient care requires individual assessment of the impact of cancer and its treatment on the functional reserve of all major organ systems. The potential of anaesthetic technique at cancer surgery to influence long-term cancer outcome merits investigation.
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Anesthesia care for patients undergoing ambulatory gynecologic surgery has improved incrementally over the past few years. Emphasis has evolved beyond the safe provision of care, because this has largely been achieved. Comfort, speed, and efficiency have taken on new importance. ⋯ Local anesthetic use in gynecologic laparoscopy appears to improve postoperative pain control modestly, especially when given into the peritoneal cavity. Supralaryngeal airways, such as ProSeal LMA, appear to provide effective ventilation in laparoscopy, although their ability to protect against aspiration is unclear. The speed and comfort of emergence, recovery, and discharge may be improved by consciousness monitoring during general anesthesia and by drugs intended to modulate hemodynamics.
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This article reviews the challenging practice of systemic analgesia as an alternative to epidural analgesia for labor pain, and places remifentanil within the context of opioid analgesics suitable for managing for labor pain. ⋯ Remifentanil is now gaining popularity. Remifentanil may be more suitable than other traditional opioids for inducing labor analgesia. Careful monitoring of the parturient and the newborn is recommended, however, to mitigate the potential for maternal and neonatal hypoxemia.
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There are several commercially available electroencephalogram-derived devices for monitoring anaesthesia depth. This article reviews all published studies describing their use in children; first assessing studies of performance in measuring anaesthesia depth in observational, physiological studies and then describing relevant outcome studies. There is also a brief discussion of why they might be useful, what physiological problems may arise and what the reader should be wary of in the methodology of these studies. The subject is approached from a clinical perspective. ⋯ The bispectral index is the most widely studied, but at this stage there is no evidence to suggest any one device is substantially superior to any other. There may be a role emerging for their use in older children, but their use in infants cannot be supported.
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Curr Opin Anaesthesiol · Jun 2007
ReviewPerioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery.
Cardiovascular disease is the leading cause of death after anesthesia and surgery. The preoperative identification of patients with underlying coronary artery disease is important to initiate appropriate treatment strategies in order to reduce the risk of perioperative complications. The current review will discuss new insights in the field of perioperative medicine that can be applied to clinical practice or stimulate further investigation. ⋯ New perceptions in perioperative medical management and novel developments in surgical and anesthesiology techniques continue to improve the cardiovascular outcome of patents undergoing major noncardiac surgery.