Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2010
ReviewPopulation pharmacokinetics and pharmacodynamics in anesthesia, intensive care and pain medicine.
Population modeling is a relatively new pharmacological discipline, the development of which has largely been stimulated by the need for accurate models for the pharmacokinetics and dynamics of anesthetic agents. ⋯ Nonlinear mixed-effect population-based modeling has become the gold standard method of pharmacokinetic and pharmacodynamic analysis during new drug development and during subsequent pharmacological studies. Population-based modeling techniques have been applied to numerous aspects of drug delivery in anesthesia, intensive care and pain medicine.
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Curr Opin Anaesthesiol · Aug 2010
ReviewPharmacokinetics and pharmacodynamics in critically ill patients.
The purpose of this review is to highlight the recently published studies in the area of pharmacokinetics and pharmacodynamics in critically ill patients and ascertain the relevance to clinical practice. ⋯ Studies have shown that critically ill patients display large variations in pharmacokinetics mainly due to altered pathophysiology. An understanding of the pathophysiological changes that occur in critically ill patients is essential to optimize dosing particularly to achieve the pharmacodynamic targets for antibiotics.
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Curr Opin Anaesthesiol · Aug 2010
ReviewRisks of anesthesia or sedation outside the operating room: the role of the anesthesia care provider.
Our goal is to review the recent year's novel and relevant literature on the practice of sedation/anesthesia in the nonoperating room setting. Risk factors and outcomes were evaluated related to locations, providers, and anesthetic regimens. ⋯ The current incidence of complications associated with sedation in the nonoperating room environment remains irresolute. Although there are many studies on sedation practices in the out-of-operating room setting, high-quality studies are lacking. There are no data comparing practice outcomes between different practitioners and specialties.
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Curr Opin Anaesthesiol · Aug 2010
ReviewStandardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room.
The purpose of this review is to summarize recommendations for the safe and efficient conductance of sedation and anesthesia at remote locations; and to define safety standards, monitoring techniques, quality of care and procedural eligibility. ⋯ Patient selection, procedure appropriateness and location appropriateness are the key elements defining the provision of safe anesthesia care outside the operating room. Titratable, short-acting intravenous drugs are preferred such as propofol and remifentanil.
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Curr Opin Anaesthesiol · Aug 2010
ReviewSugammadex: a selective relaxant-binding agent providing rapid reversal.
Sugammadex is a new reversal agent with a unique mechanism of action in anaesthesia. Because of its rapid onset of action and its efficacy in determining neuromuscular blockade at any time, it opens up new perspectives in anaesthesia. ⋯ Sugammadex binds amino-steroidal muscle relaxants by encapsulation. It enables rapid reversal of neuromuscular blockade at any time point and at any depth of block. Its effects are predictable and very reliable, in contrast to cholinesterase inhibitors. This opens up new perspectives in anaesthesia. Even an emergency reversal of high-dose rocuronium-induced neuromuscular blockade is possible with sugammadex and times to full recovery (TOF 0.9) are faster than after spontaneous recovery from suxamethonium.