Current opinion in anaesthesiology
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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.
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Curr Opin Anaesthesiol · Aug 2012
ReviewPediatric dermatologic procedures performed outside the operating room.
Pediatric dermatologic procedures performed outside of the operating room are often painful and frequently require general anesthesia. Laser procedures constitute a relatively small but significant group of the growing number of these encounters. This article reviews relevant dermatological pathophysiology, current treatment modalities and collates currently available evidence to inform the best practice in anesthetic care of these patients. ⋯ Anesthesiologists are increasingly providing care for children undergoing dermatologic out-of-operating room procedures. Similar general considerations for out-of-operating room anesthesia equally apply to children undergoing these procedures. There are few recently reported data pertaining to this patient population and further work is needed.
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This review will discuss the most recent developments in pharmacogenetics of commonly used perioperative medications, new collaboration networks in the field of personalized medicine, and future clinical implications of pharmacogenetics. ⋯ In the near future, pharmacogenetic approaches may facilitate personalized perioperative intervention trials.