Best practice & research. Clinical anaesthesiology
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An 'ideal' anaesthetic can be approached by using a combination of different compounds. A variety of anaesthetic techniques has been described to ensure safe administration and an early recovery with high patient satisfaction. In particular, the inhalational anaesthetics desflurane and sevoflurane, with their rapid pharmacokinetics, re-established the notion of balanced anaesthesia as an equivalent, well-controllable technique. With the choice of anaesthetics and anaesthetic adjuvants clinically available today, especially the combination of a volatile anaesthetic with a short-acting opioid, balanced anaesthesia represents a big step towards an ideal anaesthetic.
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The volatile anaesthetics sevoflurane and desflurane feature new and promising properties. Their low blood and tissue solubility enables rapid onset of and emergence from anaesthesia, thus enhancing patient safety and comfort. ⋯ The first part focuses on pharmacokinetic issues such as substance properties, uptake and elimination. The second part covers the effects of inhaled anaesthetics on organ systems, with emphasis on the central nervous system, the cardiovascular system, the respiratory tract, liver and kidneys.
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Best Pract Res Clin Anaesthesiol · Sep 2005
ReviewThe concept of anaesthetic-induced cardioprotection: clinical relevance.
Experimental evidence has clearly demonstrated that volatile anaesthetic agents have direct protective properties against reversible and irreversible ischaemic myocardial damage. These properties have been related to a direct preconditioning effect but also to an effect on the extent of reperfusion injury. ⋯ This potential application of anaesthetic agents has only recently been explored, and its applicability in clinical practice is the subject of ongoing research. This review summarizes the current knowledge on this subject.
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Anaesthetic agents display remarkable neuroprotective potential; here, we describe the evidence supporting its use and highlight areas for future development of the field. In particular the application of isoflurane and/or xenon as inhalational neuroprotectants is advocated and evidence for the neuroprotection provided by barbiturates and suppression of cerebral metabolic rate is discussed.
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Best Pract Res Clin Anaesthesiol · Sep 2005
ReviewInert gases as the future inhalational anaesthetics?
Of all the inert gases, only xenon has considerable anaesthetic properties under normobaric conditions. Its very low blood/gas partition coefficient makes induction of and emergence from anaesthesia more rapid compared with other inhalational anaesthetics. ⋯ Xenon causes several physiological changes, which mediate protection of the brain or myocardium. The use of xenon might therefore be beneficial in certain clinical situations, as in patients at high risk for neurological or cardiac damage.