Current opinion in anaesthesiology
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Morbid obesity alters drug dose requirement and time course of drug response. In addition, morbid obesity's impact on many organ systems decreases the margin of safety of anesthetic drugs. Consequently, incorrect dosing will increase the rate of perioperative complications. In this review, we will discuss factors that affect the pharmacokinetics and pharmacodynamics of anesthetic agents in the obese population, we specify certain dosing scalars, and we relate our current knowledge of obesity's effects on the clinical pharmacology of anesthetic drugs. ⋯ For the induction dose of hypnotics and the initial dose of other drugs that have a fast onset of effect, cardiac output or LBW are relevant dosing scalars. For maintenance dosing, LBW seems to be a more appropriate dosing scalar than total body weight.
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Ketamine has been repeatedly reviewed in this journal but novel developments have occurred in the last few years prompting an update. Interesting recent publications will be highlighted against a background of established knowledge. ⋯ More questions have arisen than have been answered. Some have very grave implications. The issue of neuroapoptosis must be clarified. The long-term effects must be further investigated. On the bright side the effects on postoperative delirium, as well as the anti-inflammatory and antidepressive effects, might open new vistas for an old drug.
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The purpose of this review is to focus on recent literature about sedation or anaesthesia in paediatric MRI. Special features of the MRI working environment, recent studies about sedation or anaesthesia, and success rates and risk profiles in this setting are presented. Finally, information for physicians to decide between sedation or anaesthesia in individual situations is presented. ⋯ The MRI unit is a work station where all processes have to be well planned and staff trained to guarantee maximum patient safety, superior quality of imaging and economic needs. For optimal performance trained, experienced and certified personnel, appropriate drugs for the individual patient risk profile and sufficient monitoring equipment are essential.