Current opinion in anaesthesiology
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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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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
ReviewInduced changes in protein receptors conferring resistance to anesthetics.
Although general anesthetics have been provided effectively for many years, their exact molecular underpinnings remain relatively unknown. In this article, we discuss the recent findings associated with resistance to anesthetic effects as a way of shedding light on these mechanisms. ⋯ Information about the possible targets and molecular nature of anesthetic action is being derived from studies of anesthetic resistance in γ aminobutyric acid receptors, tandem pore potassium channels, and an apparently wide variety of protein systems within the nematode, Caenorhabditis elegans.
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Can a general anesthetic binding to its membrane receptors alter global brain activity to cause loss of consciousness? ⋯ An important feature of general anesthesia is a preferential inhibition of global feedback connectivity when general anesthetics bind to allosteric sites of gamma-aminobutyric acid receptors present in the cerebral cortex.
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Cardiac arrhythmias are a major source of morbidity and mortality. Many of these patients require diagnostic or therapeutic intervention in an electrophysiology laboratory with involvement of an anesthesiologist. The goal of this review is to provide the anesthesiologist with a comprehensive understanding of the mechanisms underlying various arrhythmias; specific procedures performed for diagnosis and treatment, and associated risks. ⋯ By reviewing the current literature regarding electrophysiology procedures, this review will provide information essential to the anesthesiologist to safely care for this unique patient population.