Current opinion in anaesthesiology
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Since the detection of morphine by the pharmacologist Friedrich Sertürner in 1806, opioids have been used as potent centrally acting analgesics. In addition to the central site of action, peripheral endogenous opioid analgesic systems have been extensively studied, especially in the past two decades. This review is not only mentioned to give a brief summary in this well investigated field of peripheral opioid receptors, but also to highlight the role of peripheral opioid receptors in other physiological and pathophysiological conditions. ⋯ Efforts continue to develop opioid analgesics unable to cross the blood-brain barrier, which act only peripherally in low doses, thus providing adequate analgesia without central and systemic side-effects.The awareness of the influence of peripheral opioid receptors beyond nociception may also have therapeutic ramifications on the other fields mentioned above. For example, the treatment of opioid-induced bowel dysfunction by methylnaltrexone is one of the major findings in the previous years.
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthesia and the developing brain: are we getting closer to understanding the truth?
Due to increased frequency of surgical interventions, infants and young children are exposed to anesthesia, often repeatedly, during an extremely delicate period of brain development. We review new evidence that continues to challenge the safety of this practice. ⋯ Although clinical importance remains to be substantiated, results to date do indicate that exposure of animals to general anesthesia during active synaptogenesis is most detrimental. Accordingly, it is essential to determine when synaptogenesis begins and ends in developing humans. It is also imperative that effective preventive techniques be developed so that existing anesthetics can be used with minimum risk of neurotoxic side-effects of anesthesia.
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Curr Opin Anaesthesiol · Aug 2011
ReviewThe anaesthetic management of caesarean section in the interventional radiology suite.
Interventional radiology has been used in the last decade for the management of major obstetric haemorrhage particularly when the placenta is pathologically adherent (accreta) or for postpartum haemorrhage when a bleeding vessel is suspected. This review describes the radiological, obstetric and anaesthetic interventions which are often carried out in the radiology suite. ⋯ This review describes the management of patients who are amenable to prophylactic or emergency radiological intervention for obstetric haemorrhage in the radiology suite. Controversy surrounds the optimum place for surgery and the most suitable mode of anaesthesia in these patients.
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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.