Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Aug 2011
ReviewIntraoperative management of pulmonary arterial hypertension in infants and children--corrected and republished article.
Pediatric pulmonary arterial hypertension (PAH) continues to be a considerable problem to the pediatric anesthesiologist even if its management has seen remarkable advances in recent years. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, form an appropriate anesthetic management plan. A review of some of the latest medical advances will provide the reader with a better understanding of the most current anesthetic management options. ⋯ The first important aspect of anesthetic management is to provide adequate intraoperative anesthesia and analgesia while minimizing increases in pulmonary vascular resistance and myocardial. Depending on the procedure, these goals can be met with the administration of either sedation/analgesia or general anesthesia together with new drugs for PAH treatment in association with a high potential for adverse events.
-
Curr Opin Anaesthesiol · Aug 2011
ReviewEffects of anaesthesia on the inflammatory response to injury.
The systemic inflammatory response to injury is essential for wound healing and recovery in concert with other endocrinological, metabolic and immunological changes. However, recent studies suggest that a hyperinflammatory state is associated with adverse perioperative outcomes. Therefore interventions that modulate the inflammatory response, surgical, anaesthetic and pharmacological, may enhance recovery with fewer complications. ⋯ The use of an interleukin-1 receptor antagonist to control wound pain and limit local inflammation is under consideration. The role of glucocorticoids in obtunding the inflammatory response to injury with improved outcome requires confirmation with better-quality trials. Systemic lidocaine is anti-inflammatory but is effective only in abdominal surgery. NSAIDs are neglected, despite their widespread clinical use and merit detailed investigation.
-
Interventional neuroradiology is a rapidly expanding speciality. The aim of this review is to provide the anaesthetist with an up-to-date summary of current and future advances in interventional neuroradiology. ⋯ Providing safe care to patients in the remote radiology suite requires a clear understanding of the complexity of procedures being undertaken, potential complications and careful, thorough assessment of patients.
-
Curr Opin Anaesthesiol · Aug 2011
ReviewLinking inflammation and coagulation: novel drug targets to treat organ ischemia.
Activation of the coagulation system during ischemia/reperfusion injury is an unavoidable event and even further augmented during cardiovascular surgery. Clotting not only leads to disturbance of blood rheology but also enhances the inflammatory response. We aim to highlight the inflammatory properties of the coagulation system and novel potential therapeutic approaches targeting both features. ⋯ Ischemia and reperfusion are common activators of coagulation that is also accompanied by inflammation. Therefore, targeting this well orchestrated system might be of therapeutic benefit, as its mode of action is dual: clotting inhibition and anti-inflammation. This novel therapeutic approach might at least be of benefit in the treatment of systemic inflammatory syndromes following, that is, cardiovascular surgery.