Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2008
Review Meta AnalysisDoes supplemental oxygen reduce postoperative nausea and vomiting? A meta-analysis of randomized controlled trials.
Studies on the ability of supplemental oxygen to decrease the incidence of postoperative nausea and vomiting (PONV) are inconsistent, with initial studies suggesting benefit while subsequent trials demonstrate no decrease in PONV. ⋯ The positive results of two initial studies reducing the risk for PONV in patients given 80% Fio(2) were not confirmed by any of the subsequent trials. Considering all available evidence, 80% Fio(2) should no longer be considered an effective or reliable method to reduce overall PONV.
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Anesthesia and analgesia · Jun 2008
ReviewAn assessment of the effects of general anesthetics on developing brain structure and neurocognitive function.
Neuronal cell death after general anesthesia has recently been documented in several immature animal models. Worldwide, volatile anesthetics are used in millions of young children every year during surgical procedures and imaging studies. The possibility of anesthesia-induced neurotoxicity during an uneventful anesthetic in neonates or infants has led to serious questions about the safety of pediatric anesthesia. However, the applicability of animal data to clinical anesthesia practice remains uncertain. In the present review, we assess the evidence for the effects of commonly used anesthetics on neuronal structure and neurocognitive function in newborn humans and animals. ⋯ The evidence for anesthesia-induced neurodegeneration in animal models is compelling. Although this phenomenon has not been prospectively studied in young children, anecdotal data point toward the possibility for neurological impairment after surgery and anesthesia early in life. Given the serious implications for public health, further investigations of this phenomenon are imperative, both in laboratory animals and in young children.
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Anesthesia and analgesia · Jun 2008
ReviewStrategies and experimental models for evaluating anesthetics: effects on the developing nervous system.
Advances in pediatric and obstetric surgery have resulted in an increase in the duration and complexity of procedures requiring anesthesia. It has been reported that anesthetic drugs cause widespread and dose-dependent apoptosis in the developing rat brain. The similarity of the physiology, pharmacology, metabolism, and reproductive systems of the nonhuman primate to that of the human, especially during pregnancy, make the monkey an exceptionally good animal model for assessing potential neurotoxic effects of anesthetics. ⋯ Although ketamine use in pediatric anesthesia is relatively limited, the findings of the studies are sufficiently strong to merit concern about the N-methyl-d-aspartate antagonist drugs as a class. Our focus on ketamine should not be construed as implying that the risk of neurodegeneration with ketamine is greater, or less, than with other anesthetics. We are simply describing the effects where we have the most preclinical data.