AANA journal
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The practice of anesthesia has long been considered an art and a science, with interpatient variability in drug response being the rule, rather than the exception. Pharmacogenomics, which studies the role of genetics in drug response, is emerging as a discipline that may impact anesthetic management. The purpose of this review is to provide clinicians with basic knowledge related to pharmacogenomics and its implications in anesthesia. ⋯ Pharmacogenomics as a predictor of drug response is increasingly used in medicine and drug development. By expanding the knowledge base of anesthesia providers, pharmacogenomic considerations have the potential to improve therapeutic outcomes and individualize drug therapy, while avoiding toxic effects and treatment failure. However, because pharmacogenomics may not fully explain variability in drug response, implementation should be in conjunction with traditional anesthesia considerations.
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Discovered in 1898 by British chemists, xenon is a rare gas belonging to the noble gases of the periodic table. Xenon is used in many different ways, from high-intensity lamps to jet propellant, and in 1939, its anesthetic properties were discovered. ⋯ As technology in anesthetic delivery improves, xenon is being investigated further as a possible replacement for nitrous oxide as an inhalational agent. This article reviews the anesthetic properties of xenon and current and potential research about the gas.
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An exciting revolution in pediatric pain control has evolved in anesthesia during the past 2 decades. The creative use of systemic analgesic techniques has dramatically improved the quality of postoperative pain management. The postsurgical pediatric population is reaping the benefits of such advancements in acute pain management, as there is an increasing use of patient-controlled analgesia (PCA). ⋯ This review of the literature addresses safety issues, indications, contraindications, complications, and dosing regimens related to pediatric PCA. Recommendations for continuous pulse oximetry and sedation monitoring, along with individualized dosage requirements, are presented to decrease the incidence of complications. Overall, the literature shows that PCA provides adequate pain control and high levels of satisfaction for the pediatric postsurgical population and their families.
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Case Reports
Case report: management of elective cesarean delivery in the presence of placenta previa and placenta accreta.
The rate of cesarean delivery in the United States is at an all-time high. With the increased rate of primary and repeated cesarean delivery, a corresponding increase in the occurrence rate of placenta previa and placenta accreta has been observed. ⋯ A review of the actual management and course of a patient undergoing elective cesarean delivery with the aforementioned concurrent disorders will be undertaken. This will be followed by a general discussion related to the management of an obstetric patient undergoing elective cesarean delivery with known placenta previa and placenta accreta.
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Tumors of and trauma to the trachea and bronchi can result in loss of integrity of the airway and death. Once treated primarily with thoracic surgery, these conditions are increasingly being managed with interventional pulmonary procedures outside the operating room but requiring the assistance of anesthetists. ⋯ In addition, anesthetists may care for patients undergoing nonpulmonary surgery who have an existing bronchial or tracheal stent or patients requiring correction of displaced stents. A discussion on the preferred methods for caring for patients in these situations is included.