Current opinion in anaesthesiology
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Populations across the world are getting older and requiring more surgery. Elderly patients present unique challenges to the anesthesiologist and anesthesia-care team. This review addresses some concerns when caring for an elderly patient. Specifically, we discuss postoperative cognitive decline (POCD) and postoperative delirium, perioperative beta-blockade and use of newer drugs, as well as older drugs. ⋯ Elderly patients require focused diligent care. They are particularly sensitive to the many drugs that are administered in the perioperative period. Recent data suggest that POCD is a real concern, but it is unclear what, if anything, can be done to prevent this complication. Beta-blocker therapy is beneficial in select patients but its widespread use cannot be supported.
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Interventions in the cardiac catheterization laboratory (CCL) requiring anaesthetic expertise are becoming routine. These interventions involve a heterogeneous patient population and take place in an offsite location. This review aims to give an insight into anaesthetic issues surrounding certain interventions and the challenges encountered in an offsite location. ⋯ Interventions in the CCL have developed to such an extent that dedicated anaesthesia teams are required in order to cope with the complexities of the patient populations, the interventions and the challenges brought by the offsite nature of the CCL.
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Curr Opin Anaesthesiol · Aug 2010
ReviewAnesthesia for balloon dilatation of esophageal strictures in children with epidermolysis bullosa dystrophica: from intubation to sedation.
Dystrophic epidermolysis bullosa is a rare disease mainly affecting small children. They often have to undergo different surgical procedures, for example balloon dilatation following esophageal strictures to maintain oral intake and prevent malnutrition. ⋯ In this article implications for the anesthetic management of children with dystrophic epidermolysis bullosa are described. General anesthesia and sedation techniques are feasible if specific prerequisites are fulfilled. The team providing anesthesia and endoscopy must be familiar with the nature and disabilities of this disease. Coordinated care of the involved disciplines is crucial for all planned procedures regarding perioperative management.
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Curr Opin Anaesthesiol · Aug 2010
Editorial ReviewAzole antimycotics and drug interactions in the perioperative period.
A beneficial effect of antifungal prophylaxis on the prevention of invasive fungal infections has increased the use of azole antimycotics in intensive care and during the perioperative period. At the same time more severe illnesses are treated and multiple drug therapies are employed. Thus, the potential for severe drug-drug interactions has increased. Previous studies have shown that azole antimycotics increase the risk of many clinically significant drug interactions with potentially hazardous consequences. ⋯ This review focuses on azole antimycotics and anesthetic drugs being used during the perioperative period and discusses the possible clinically significant drug-drug interactions. Azole antimycotics are amongst the strongest inhibitors of CYP-mediated drug metabolism. Anesthesiologists must be aware of the interaction potential of azole antimycotics to be able to adjust their perioperative strategies according to the patient's condition and concomitant medication.
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Curr Opin Anaesthesiol · Jun 2010
ReviewAre there still limitations for the use of target-controlled infusion in children?
Target controlled infusion (TCI) devices are gaining popularity among paediatric anaesthesia practitioners because propofol and short-acting opioids allow rapid onset and offset of action, reduce postoperative nausea and vomiting, reduce emergence delirium, lessen exposure to atmospheric pollutants and can be used in peripheral locations. Widespread use remains limited and this review examines reasons why children do not yet enjoy such benefits. ⋯ Hardware limitations, a lack of integrated pharmacokinetic/pharmacodynamic studies and target monitoring issues restrict use. Intravenous induction remains a hurdle, but increasing familiarity with the technique guarantees continued use for maintenance anaesthesia.