Articles: function.
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Anesthetics influence a wide variety of transmitter- and voltage-gated ion channels in the mammalian central nervous system. At the molecular level, the gamma-aminobutyric acid (GABA) subtype A receptor has emerged as a primary therapeutic target. This review highlights recent advances in our understanding of how anesthetics modify GABA(A) receptor function. ⋯ Detailed insights into anesthetic-GABA(A) receptor interactions have resulted in intense efforts to develop safer drugs that selectively target subtypes of GABA(A) receptors.
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Rofecoxib was the first specific inhibitor of cyclooxygenase-2 (COX-2) approved for the treatment of acute pain. It has been shown to provide analgesia that is significantly better than placebo and has an onset of action and efficacy similar to that of traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. In addition, the analgesic efficacy of rofecoxib has been demonstrated to be superior to that of the opioid combination of codeine 60 mg/acetaminophen 600 mg in an acute dental pain model. ⋯ Rofecoxib is a safe and highly effective alternative to previously available NSAIDs and should be considered for the treatment of acute pain conditions in adult patients, especially those at risk for developing gastrointestinal complications. It is preferred in the perioperative setting because of its analgesic efficacy and lack of platelet effects. Because of its more favorable gastrointestinal toxicity profile compared with nonselective NSAIDs, rofecoxib is safer in patients, especially older patients, for whom chronic anti-inflammatory or analgesic therapy is indicated.
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Closed-loop systems are able to make decisions on their own and try to reach and maintain a preset target. As a result, they might help the anaesthesiologist in optimizing the titration of drug administration without overshooting, controlling physiological functions and guiding monitoring variables. Thanks to the development of fast computer technology and more reliable pharmacological effect measures, the study of automation in anaesthesia has regained popularity. ⋯ Until now, most of these systems are still under development. The challenge is now to establish fully the safety, efficacy, reliability and utility of closed-loop anaesthesia for its adoption into the clinical setting. Besides the optimization of controlled variables and control models, these systems have to be tested in extreme circumstances.
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The capabilities of interventional radiology are developing faster than perhaps any other branch of medicine. Coupled with and fuelled by parallel advances in computer technology, medical physics and developments in endovascular catheter technology, interventional radiologists are innovating not only replacements for open surgeries, but entirely new therapies as well. This has, however, provided a range of new potential complications for the patient and, in contrast to other areas, presents risks for the anesthesiologist as well. ⋯ In the light of these new developments in interventional radiology there is much research to be done. Further developments in imaging and computer processing technology will doubtless make possible the real time integration of anatomical image with metabolic state and functional anatomy. The impact of the hazards of these new techniques on the safety of anesthesia has, however, been the subject of virtually no research. A particularly needy area will be the ergonomics of the delivery of anesthesia care in these new environments.
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Most peripheral neuropathies involve large as well as small-fiber dysfunction. A small subset of neuropathies present with restricted or predominant small-fiber involvement. ⋯ Small-fiber neuropathies are a heterogeneous group of disorders. They vary in etiologies and require special attention, as many disorders are rare and the differential diagnosis is broad. Evaluation is often extensive and may need pathologic specimen. Many patients respond to symptomatic therapy, but some are difficult to treat.