Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Aug 2016
ReviewPractical considerations in the management of sedation for colonoscopy.
The purpose of this review is to discuss the unique elements of providing anesthesia services for colonoscopy including the practical issues within an endoscopy suite, nothing by mouth status for colonoscopy, chronic medication instructions, appropriate anesthesia equipment, informed consent, pharmacology of agents for sedation, anesthetic techniques, and issues related to postprocedural care. ⋯ Sedation for colonoscopy is a rapidly expanding subspecialty with special needs created by the increasing medical complexity of the patients, the demands of the endoscopy procedures, the challenges of the endoscopy suite, and the rapid turnover of the outpatient environment.
-
Curr Opin Anaesthesiol · Aug 2016
ReviewModel-based drug administration: current status of target-controlled infusion and closed-loop control.
Drug administration might be optimized by incorporating pharmacokinetic-dynamic (PK/PD) principles and control engineering theories. This review gives an update of the actual status of target-controlled infusion (TCI) and closed-loop computer-controlled drug administration and the ongoing research in the field. ⋯ Evidence in the literature is increasing that TCI and closed-loop technology could assist the anaesthetists to optimize drug administration during anaesthesia.
-
Standards for capnography inside operating theatres in high and middle-income countries are well recognized and implemented. This review examines recent standards and recommendations for the use of capnography outside the operating room and their rationale and development. ⋯ Established standards for using capnography within the operating theatre have significantly improved patient safety and it is hoped that the recent publication of new but similar capnography standards for application outside the operating theatre will do the same there. The reasons for the current low levels of implementation of some of these standards outside the operating room are worthy of further research.
-
Curr Opin Anaesthesiol · Aug 2016
ReviewOpioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery?
Cancer is now one of the leading causes of death worldwide, and excisional surgery is an essential treatment for the four most common adult cancers. Opioids remain the most commonly prescribed analgesics in the perioperative period of cancer surgery, yet the question of whether opioids could influence recurrence or metastasis remains unanswered. ⋯ Prospective randomized trials are required to investigate this important topic further. Several are currently ongoing. Until the results of these are available for scrutiny, there is currently insufficient evidence to recommend any changes to current clinical practice. Opioids continue to play an important role in the perioperative period.