Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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There has been a breakthrough in the understanding of anaesthetic drug effects during the last two decades, and new monitors aimed at quantifying such effects have been developed. ⋯ Even though the BIS technology is promising and used widely, no health authorities have so far recommended that such monitors should be compulsory during general anaesthesia, but rather that it should be considered on an individual basis. So far, it seems like this is a sensible approach in Norway as well.
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Tidsskr. Nor. Laegeforen. · Mar 2010
Review[Modern pharmacological principles for intravenous anaesthesia].
Anaesthetic pharmacology is characterized by use of drugs in high doses for a short period of time. Knowledge of pharmacokinetics is important for precise control of drug effects (onset, maintenance and offset). ⋯ Knowledge of pharmacologic principles and modeling from studies on volunteers and patients form the basis for good clinical monitoring of anaesthetic drug effects.
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Patients with cardiac disease have a higher incidence of cardiovascular events after non-cardiac surgery than those without such disease. This paper provides an overview of perioperative examinations and treatment. ⋯ Little evidence supports the use of different anaesthetic methods in cardiac patients that undergo non-cardiac surgery than in other patients. Stable circulation, sufficient oxygenation, good pain relief, thromboprophylaxis, enteral nutrition and early mobilization are important factors for improving the perioperative course. Close cooperation between anaesthesiologist, surgeon and cardiologist improves logistics and treatment.
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Benzodiazepines are probably prescribed too often to people with substance abuse problems. The drugs often alleviate symptoms effectively on a short term, but pharmacodynamic interactions and development of dependence cause problems. Indistinct, but important side effects might be overlooked or misunderstood. Evidence-based practice should replace prescriptions based on unclear indications.