Anesthesiology clinics of North America
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The genetic evaluation of the ryanodine type one receptor (RYR1) gene is unlikely to be a useful screening test of malignant hyperthermia susceptibility. But when significant suspicion of malignant hyperthermia has been raised by well-documented clinical events or strong family history, the genetic evaluation of RYR1 could secure a diagnosis and indicate appropriate treatment for both the index patient and many relatives of all ages, including the youngest.
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Anesthesiol Clin North America · Dec 2005
ReviewPreoperative psychological preparation of the child for surgery: an update.
Preoperative anxiety is associated with a number of poor postoperative outcomes and with significant parental and child distress before surgery. Preparing children for surgery can prevent many behavioral and physiologic manifestations of anxiety. Psychologic and behavioral interventions and pharmacologic interventions are available to treat preoperative anxiety in children. This article discusses the psychologic preparation of children for surgery.
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The future of regional anesthesia in children is to continue to use current techniques, but also to search for ways to make them easier to employ. The potential development of safe local anesthetic agents with much longer durations, will serve to facilitate improvements in the techniques and styles of practice. The advances in minimally invasive surgical techniques do not mean that regional techniques will not be necessary, but will result in an adaptation of techniques. Peripheral nerve blockade and local wound infiltration can still be used and in some instances, may be very appropriate.
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Anesthesiol Clin North America · Dec 2005
Review Historical ArticlePediatric anesthesia historical perspective.
This article examines how anesthesia evolved to serve the needs of children. Discussion includes milestones in technologic advancement related to pediatric anesthetic care and how collaboration among pediatric surgeons, neonatologists, and pediatric anesthesiologists has helped our specialty to progress. Conversely, the significant contributions of pediatric anesthesiology to pediatric critical care medicine, pain management, and pediatric public health care are also presented.
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Children are benefiting from the advances made in developmental neurobiology and analgesic pharmacology over the past few decades. Heightened public awareness and increased political pressure from external regulatory agencies are helping to maintain the momentum in improving pediatric pain management. As a result, methods of assessing and managing children's pain are being refined, and new modalities of pain relief are being explored. This review summarizes selected current topics in pediatric acute pain management, with the major emphasis on acute postoperative pain management.