Current opinion in anaesthesiology
-
Cannabinoids have been known for their analgesic, anxiolytic, antiemetic and antispastic properties for many centuries. Since an endogenous cannabinoid system has been identified in the past two decades, cannabinoids have also become the focus of interest in western medicine. This review summarizes preclinical and clinical studies on the role of the endocannabinoid system and exogenous cannabinoids in anaesthesia and pain management. ⋯ In general, the results of the very few well-conducted clinical trials often diverge from the highly interesting and promising findings of preclinical studies. Taken together, the most recent preclinical and clinical data suggest that cannabinoids should be applied as low-dose co-analgesics to inhibit neuroplasticity and central sensitization rather than as analgesics in acute pain.
-
The role of anesthesia outside the operating room is rapidly expanding and evolving alongside with the advances in interventional neuroradiology. Increasingly complex diagnostic and therapeutic neuroradiological procedures are being performed on sicker patients. This review provides an overview of the principles of anesthetic management and summarizes recent advances in interventional neuroradiology. ⋯ Providing anesthesia in the interventional neuroradiology suite continues to be a challenge to the anesthesiologist. Understanding the anesthetic constraints and complexities and keeping abreast of the current developments in neuroradiology are crucial in ensuring the maximal benefits to and safety of patients.
-
Curr Opin Anaesthesiol · Aug 2005
Arginine vasopressin as a rescue vasopressor agent in the operating room.
This review gives an overview of the current knowledge and research on the use of arginine vasopressin in cardiac arrest and severe shock states. ⋯ Whereas arginine vasopressin in combination with epinephrine can significantly increase hospital discharge in cardiac arrest, arginine vasopressin combined with catecholamines improved haemodynamics in vasodilatory and haemorrhagic shock, but effects on outcome remain unknown. Nonetheless, in the perioperative setting, arginine vasopressin may already be considered as a potent adjunct vasopressor agent in advanced shock states unresponsive to conventional therapy.
-
The development of dexmedetomidine, a potent and highly selective alpha2-adrenoceptor agonist, has created new interest in the use of alpha2-adrenoceptor agonists, and has led to its evaluation in various yet non-approved perioperative settings. The current review focuses on the usefulness of dexmedetomidine in anaesthesia practice. ⋯ Dexmedetomidine offers beneficial pharmacological properties, providing dose-dependent sedation, analgesia, sympatholysis and anxiolysis without relevant respiratory depression. The side-effects are predictable from the pharmacological profile of (2-adrenoceptor agonists. In particular, the unique sedative properties of dexmedetomidine resulted in several interesting applications in anaesthesia practice, promising benefits in the perioperative use of this compound. However, dexmedetomidine was approved for sedation in the intensive care unit in the USA in 1999, and administration in anaesthesia practice remains an 'off-label' use. Further studies are needed to establish the role of dexmedetomidine in the perioperative period.
-
Curr Opin Anaesthesiol · Aug 2005
Molecular and systemic mechanisms of general anaesthesia: the 'multi-site and multiple mechanisms' concept.
Amnesia, hypnosis and immobility are essential components of general anaesthesia. This review highlights recent advances in our understanding of how these components are achieved at a molecular level. ⋯ Clinical anaesthesia is based on drug actions at multiple anatomical sites in the brain. The finding that amnesia, hypnosis and immobility involve distinct molecular targets opens new avenues for developing improved therapeutic strategies in anaesthesia.