Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Aug 2007
ReviewCorrelating the clinical actions and molecular mechanisms of general anesthetics.
To summarize recent in-vitro and in-vivo research on molecular mechanisms of general anesthetics' actions. ⋯ Several clinically distinct 'anesthetic states' are induced by different classes of drugs acting on neuronal circuits via different molecular targets. Understanding the mechanisms underlying the therapeutic and toxic actions of general anesthetics helps us reframe the 'art' of anesthesia into more of a 'science'. These studies also enhance efforts to develop new drugs with improved clinical utility.
-
Curr Opin Anaesthesiol · Aug 2007
ReviewAnesthesia practice in the emergency department: overview, with a focus on airway management.
To review the need for interdisciplinary collaboration to reduce human and system-related errors in the emergency care setting. ⋯ The implications of collaboration are sweeping; not only for optimizing patient care but leading to a 'win-win' situation for medical personnel by improving relationships to better address global needs and optimize the opportunities for collaboration, which is particularly true for urgent/emergent airway management.
-
Dentistry treatment is one of the most anxiety-inducing events in people's lives. The development of pain and anxiety-control techniques has always been very closely aligned to the development of dentistry. The purpose of this review is to summarize the recent literature in this field. ⋯ Considerable progress is being made with a number of innovative techniques. Oral midazolam for children and patient-controlled propofol show very promising results. More research is needed before propofol can be recommended for use without anaesthetic staff. The recently published systematic review of sedation in children outlines gaps in the literature and contains recommendations for future work.
-
Curr Opin Anaesthesiol · Aug 2007
ReviewSedation for gastrointestinal endoscopy: the changing landscape.
Most patients require sedation for gastrointestinal endoscopy. Moderate sedation for these procedures has traditionally been provided by the endoscopist with benzodiazepine and/or a narcotic. As endoscopy has increased in numbers and complexity, however, more effective sedation and analgesia is frequently required. Controversy has ensued over safe and efficient sedation practice. This review seeks to delineate what has been learned about this topic in the recent literature. ⋯ Alternatives to anesthesiologist-supervised propofol include nurse-administered propofol sedation supervised by the endoscopist, and patient controlled sedation. While other sedative regimens continue to be examined, the use of propofol for gastrointestinal endoscopy will continue to increase. Structured nurse-administered propofol programs appear to be safe, but the occurrence of severe respiratory depression and the ability to rescue remain concerns. Further study into appropriate sedation training, patient selection, ability to rescue, complications and value of anesthesiologist-directed sedation is necessary.
-
The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic. ⋯ The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.