Current opinion in anaesthesiology
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Sugammadex is a novel drug that binds selected neuromuscular blocking drugs and prevents them from acting at the neuromuscular junction. Due to its rapid onset and relative lack of side effects, this drug promises to change the method of anesthesia delivery. This review summarizes the literature on the drug and addresses some of the potential changes that it may bring. ⋯ Sugammadex binds neuromuscular blocking drugs and encapsulates them, making cholinesterase inhibitors unnecessary. Its rapid reversal of blockade makes it possible to keep patients profoundly muscle relaxed until drapes come down and it can enable a rapid return to spontaneous ventilation in a 'cannot intubate, cannot ventilate' situation. Costs and date of availability have yet to be determined.
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Curr Opin Anaesthesiol · Aug 2007
ReviewBlood substitutes as pharmacotherapies in clinical practice.
To discuss the development and current status of blood substitutes, including hemoglobin-based oxygen carriers (HBOCs) and perfluorocarbons. Research in this field offers an important view into the future of transfusion medicine in the operating room, as well as in trauma and combat arenas. ⋯ Polymerized hemoglobin preparations have proven most successful in clinical trials due to their improved side-effect profile. The goal is to evaluate blood substitutes with enhanced intravascular retention, reduced osmotic activity, and attenuated hemodynamic derangements such as vasoconstriction. Although not without substantial morbidity and mortality, the current safety of allogeneic blood transfusion demands that comparative studies show minimal adverse effects, as well as efficacy and potential for novel applications.
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Curr Opin Anaesthesiol · Aug 2007
ReviewThe nature of anesthesia and procedural sedation outside of the operating room.
Procedural sedation and monitored anesthesia care have become increasingly common in locations outside of the operating room. The different types of procedures are presented along with pertinent safety issues with the use of different drug combinations. ⋯ The number and types of procedures done outside of the operating room are steadily increasing. Sedation for these is often provided by nonanesthesiologists. A quality assurance system dedicated to track events associated with procedural sedation and anesthesia done outside of the operating room is instrumental for the maintenance of exemplary quality of sedation and safety of our patients.
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This review summarizes the current anesthetic management of patients undergoing craniotomies in the awake state. ⋯ A safe and acceptable analgesic/amnestic state for these procedures can be provided by the use of dexmedetomidine, with or without the addition of remifentanil.
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The cardiac catheterization lab has concerns for both patient care and for safety. As the cardiac catheterization lab continues to evolve, the demand for anesthesia services will certainly increase. The role of the anesthesiologist in the cardiac catheterization lab must be defined in this changing environment. ⋯ The anesthesiologist is becoming an integral part of the cardiac catheterization lab team, and an important element in maintaining a high level of patient care with minimal complications in the evolving modern day cardiac catheterization lab.