Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2012
ReviewAnesthetic management of endovascular procedures for cerebrovascular atherosclerosis.
The article reviews the treatment options for cerebrovascular atherosclerosis and highlights the challenges of anesthesia in this complex group of patients. ⋯ The anesthetist plays a key role in the endovascular management of patients with cerebrovascular atherosclerosis. Optimization of comorbidities, meticulous control of systemic physiologic variables and aggressive management of complications contribute to enhanced patient outcome.
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Curr Opin Anaesthesiol · Aug 2012
ReviewThe current status of procedural sedation for pediatric patients in out-of-operating room locations.
To illustrate the changes that are occurring in the rapidly growing field of pediatric sedation. In the USA and throughout the world, children receive sedation from a multitude of specialists with varying levels of training. The current pediatric sedation literature reflects a growing body of sedation literature by medical specialists other than anesthesiologists. This article will review the controversial use of propofol by nonanesthesiologists and the manner in which this varied group of providers along with government entities, regulatory agencies, and national organizations contribute to the continuing evolution of sedation practices. ⋯ The direction of pediatric sedation is no longer solely under the leadership of anesthesiologists. The use of anesthetic agents, including propofol, have been administered by nonanesthesiologists and reported as safe and effective agents. Nonanesthesiologists and governmental and regulatory agencies influence the delivery of sedation services. The future direction of pediatric sedation will ultimately depend upon the ability of anesthesiologists to collaborate with specialists, hospital administrators, credentialing committees, and oversight agencies in order to provide high-quality efficient sedation services to children.
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Curr Opin Anaesthesiol · Aug 2012
ReviewMonod-Wyman-Changeux allosteric mechanisms of action and the pharmacology of etomidate.
Formal Monod-Wyman-Changeux allosteric mechanisms have proven valuable in framing research on the mechanism of etomidate action on its major molecular targets, γ-aminobutyric acid type A (GABAA) receptors. However, the mathematical formalism of these mechanisms makes them difficult to comprehend. ⋯ Allosteric co-agonism provides a robust framework for design and interpretation of structure-function experiments aimed at understanding where and how etomidate affects its GABAA receptor target molecules.
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Pain management is one of the most important fields in the practice of anesthesiology. The concept that genes involved in the absorption, metabolism, and receptor affinity of analgesics are critical to a drug's efficacy is becoming widely accepted. A review of pharmacogenomics and how it affects the response to analgesics, mainly opioids, is presented in this article. ⋯ Through increased knowledge in the area of pharmacogenomics, it is hoped that that treatment of pain will move into the realm of personalized medicine. This should result in greater treatment success and a reduction of significant side-effects.
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Curr Opin Anaesthesiol · Aug 2012
The use of high-frequency jet ventilation for out of operating room anesthesia.
High-frequency jet ventilation is a novel technique for providing mechanical ventilation in the out of operating room (OOR) setting. Case reports and a small series of patients have shown it to be useful in patients undergoing cardiac arrhythmia ablations, interventional radiology procedures, and extracorporeal shock wave lithotripsy. Recently, interest in the technique has grown tremendously as the ability to provide superior surgical conditions may lead to improved efficiency and less side-effects in a variety of procedures. ⋯ Technological advances are allowing an increasing number of surgical procedures to be performed in the OOR setting. Such procedures often depend on the precise application of ablation catheters or shock waves. High-frequency jet ventilation facilitates the improved accuracy of catheter and shock wave placement, as well as efficiency of a variety of procedures. Improved efficiency, with fewer side-effects, has tremendous implications for the growth of such procedures in the OOR setting.