Best practice & research. Clinical anaesthesiology
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There has been significant research to develop an ideal synthetic opioid. Opioids with variable properties possessing efficacy and with reduced side effects have been synthesized when compared to previously used agents. ⋯ This review will discuss TRV130 receptor modulators and other novel opioid receptor modulators, including Mitragyna "Kratom," Ignavine, Salvinorin-A, DPI-289, UFP-505, LP1, SKF-10,047, Cebranopadol, Naltrexone-14-O-sulfate, and Naloxegol. In summary, the structural elucidation of opioid receptors, allosteric modulation of opioid receptors, new opioid modulators and agonists, the employment of optogenetics, optopharmacology, and next-generation sequencing of opioid receptor genes and related functionality should create exciting new avenues for research and therapeutic development to treat conditions including pain, opioid abuse, and addiction.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewNewer propofol, ketamine, and etomidate derivatives and delivery systems relevant to anesthesia practice.
Drug discovery is the cornerstone of developments in the field of anesthesia. Each year, new drugs enter the market and possibly change clinical practice. The development of new anesthetics can be divided into two groups. ⋯ Next to drug development, there is also a constant search for better delivery systems for the already available anesthetics. Following open-loop systems like TIVA, new closed-loop systems have entered the market. We also discuss about SEDASYS®-Computer-Assisted Personalized Sedation System, an automatic closed-loop delivery system that provides propofol sedation for endoscopic procedures.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewWhat is new in the battle against postoperative nausea and vomiting?
The issue of postoperative nausea and vomiting (PONV) still poses a significant burden on our patients. Although rarely associated with a life-threatening condition, it is consistently considered as one of the most undesirable side effects of surgery and anesthesia. ⋯ Because pharmacologic interventions for PONV are not without risks, practitioners must assess patient's risk status from low to high and consider the benefits of treatment. This review summarizes the current state of knowledge related to PONV and provides a practical approach toward risk assessment, prevention, and numerous treatment strategies.
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Local anesthetics are used for performing various regional anesthesia techniques to provide intraoperative anesthesia and analgesia, as well as for the treatment of acute and chronic pain. Older medications such as lidocaine and bupivacaine as well as newer ones such as mepivacaine and ropivacaine are being used successfully for decades. ⋯ This chapter seeks to summarize the pharmacokinetics of local anesthetics and address the role of newer local anesthetics, as well as clinical implications, safety profiles, and the future of local anesthetic research. Finally, some clinical pearls are highlighted.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewNeuromuscular blockers and reversal agents and their impact on anesthesia practice.
Neuromuscular blockers have long been an intricate part of the anesthesia regimen. The scientific progress in pharmacology and physiology has strengthened their clinical relevance, has helped to delineate with precision their medical role, and has enhanced the safety and effectiveness of their use. New frontiers in research will define further the role of these agents in modern anesthesia practice and guide their expanding and discrete clinical applications.