Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
Anaesthesia for magnetic resonance imaging and positron emission tomography.
This article reviews the important aspects of managing patients undergoing anaesthesia and monitoring for MRI and PET. ⋯ The availability of high-field MRI and other complex imaging studies, like PET is increasing. This requires that anaesthesiologists and critical care physicians understand the principles, safety concerns and appropriate management of patients undergoing imaging within such environments.
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Hypoxia represents one of the strongest transcriptional stimuli known to us. In most cases, hypoxia-induced changes in gene expression are directed towards adapting tissues to conditions of limited oxygen availability. ⋯ In the present review, we discuss the mechanisms of transcriptional adaptation to hypoxia and provide evidence supporting the hypothesis that targeting hypoxia-induced inflammation can represent novel pharmacologic strategies to improve perioperative outcomes. Currently, such strategies are being explored at an experimental level, but we hope that some of these targets can be translated into perioperative patient care within the next decade.
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthetic modulation of neuroinflammation in Alzheimer's disease.
To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. ⋯ The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
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Curr Opin Anaesthesiol · Aug 2011
ReviewNutritional pharmacology in surgery and critical care: 'you must unlearn what you have learned'.
This review highlights the rapidly evolving field of 'pharmaconutrition' by discussing the mechanistic and clinical data for calorie delivery and nutrients shown to improve outcome in surgical and ICU care. ⋯ We believe the future of surgical and ICU nutrition will involve administering specific pharmaconutrients as separate components, much like drugs are given. The current use of clinical pharmacology, molecular biology, and clinical research principles in the study of pharmaconutrients should yield answers on how to administer the right nutrients, in the right doses, at the right time in sick patients.
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Curr Opin Anaesthesiol · Aug 2011
ReviewSedation and anesthesia for the pediatric patient undergoing radiation therapy.
Radiation oncology is a cornerstone in the treatment of cancer in children. Although painless, there is a requirement for the child to lie still by themselves in the radiation treatment room, for multiple daily or twice daily treatments for up to 6 weeks. Anesthesia or sedation is usually necessary to achieve this in younger children. This review provides a brief update of the latest developments in radiation oncology and describes the current best practice in anesthesia for these children. ⋯ In the vast majority of cases, total intravenous anesthesia or sedation using propofol ensures that the child remains immobile, whilst maintaining spontaneous respiration, an unobstructed airway, and cardiovascular stability.