Current opinion in anaesthesiology
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To present the most recent publications on inhaled agents in children and their implications for clinical care. ⋯ Sevoflurane and desflurane continue to challenge our abilities to anesthetize children safely and efficiently. Although transient emergence delirium after insoluble agents is a problem, several medications may be used to attenuate it. Inhaled agents must be used with caution in children with Duchenne's muscular dystrophy as hyperkalemia may occur in young males and myocardial depression in adolescents. Rapid recovery after desflurane and single-breath inductions with sevoflurane continue to fascinate clinicians.
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This article reviews the challenging practice of systemic analgesia as an alternative to epidural analgesia for labor pain, and places remifentanil within the context of opioid analgesics suitable for managing for labor pain. ⋯ Remifentanil is now gaining popularity. Remifentanil may be more suitable than other traditional opioids for inducing labor analgesia. Careful monitoring of the parturient and the newborn is recommended, however, to mitigate the potential for maternal and neonatal hypoxemia.
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Lethal injection has come under fire as less than the peaceful, painless death it appears. Reevaluation of the process has sparked examination of the role of doctors in state-sponsored executions. ⋯ Physician involvement created and perpetuates the seriously flawed protocol of lethal injection. Physicians and particularly anesthesiologists now have the opportunity to redress the mistakes of the past, and inform the growing debate over whether and potentially how medicine should be used to kill.