Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2008
ReviewPerioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery.
Pulmonary hypertension is a condition that has a multitude of causes. Left untreated, patients with pulmonary hypertension will experience progressive symptoms of dyspnea and right heart failure resulting in significant morbidity and mortality. This review details the many evolving aspects of understanding related to pulmonary hypertension including signs and symptoms, pathophysiology, classification, anesthetic management including perioperative considerations and treatment options. ⋯ Coupled with aggressive use of improved diagnostic hemodynamic monitors perioperatively, these patients can be medically optimized during their hospitalization and possibly aid in improving their long-term prognosis.
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The present review serves as an overview update in the diverse uses of the sedative dexmedetomidine. ⋯ Dexmedetomidine is a useful medication with many clinical applications. The medication has shown efficacy in decreasing the need for opioids, benzodiazepines, propofol, and other sedative medications. Short-term sedation has been shown to be safe in studies, although hypotension and bradycardia are the most significant side effects. Dexmedetomidine has been used effectively for sedation during pediatric procedures and in the ICU. In order to reduce sympathetic tone during cardiac surgery, a low-dose dexmedetomidine infusion has been utilized. The bariatric surgery population has also been studied with dexmedetomidine because of its adequate sedation and less prevalent respiratory depression when compared with opioid administration. Dexmedetomidine is emerging as an effective therapeutic agent in the management of a wide range of clinical conditions with an efficacious, safe profile.
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Curr Opin Anaesthesiol · Aug 2008
ReviewThe role of neurokinin-1 receptor antagonists for the management of postoperative nausea and vomiting.
To review the characteristics of neurokinin-1 receptor antagonists and their potential role in the management of postoperative nausea and vomiting. ⋯ Postoperative vomiting can lead to rare but serious complications. Neurokinin-1 receptor antagonists are significantly more efficacious against postoperative vomiting than other antiemetics. Because the benefit in terms of absolute risk reduction is critically dependent on the patient's baseline risk, it is recommended to use a validated risk score to identify patients who will benefit most from prophylaxis using neurokinin-1 receptor antagonists.
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Pharmacology is one of the corner stones of anesthesia. Outcome of anesthesia is related, in part, to both pharmacodynamics and pharmacokinetics of anesthetic drugs. Recent developments have indicated that among individuals, major differences exist in pharmacological effects. In this regard, sex, age, and genetic profile are increasingly considered to be of importance. ⋯ In the future, it is expected that an individual's pharmacological needs will be based on age, sex, and genomics.
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Curr Opin Anaesthesiol · Aug 2008
ReviewRecent advancements in the treatment of lumbar radicular pain.
Lumbar radicular pain is a common and often difficult condition to treat. Current literature supports the theory that radicular pain is at least in part due to an inflammatory process involving cytokines, including tumor necrosis factor alpha and interleukins. This review summarizes some of the most recent research concerning the use of tumor necrosis factor alpha antagonists and interleukin receptor antagonists in the treatment of lumbar radicular pain. ⋯ Treatment for lumbar radicular pain has long included epidural steroids to inhibit the inflammatory component of radicular pain. Recent studies have more precisely identified the cytokines responsible for this inflammatory process and indicate that inhibition of these cytokines may offer more specific and effective treatment for lumbar radicular pain.