Current opinion in anaesthesiology
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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.
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Anesthesiologists may face problematic situations when patients are close to death, in which clinical problems, decision-making processes, and ethical issues are often interconnected and dependent on each of them. The aim of this review is to assess the recent literature regarding the anesthesiological role for advanced cancer patients. ⋯ Anesthesiologists should be competent in all aspects of terminal care, including the practical and ethical aspects of withdrawing different modalities of life-sustaining treatment and the use of sedatives, analgesics, and nonpharmacologic approaches to easing the suffering of the dying process. More research is needed to provide models which should be spread in the scientific community to afford this difficult task.