Anesthesia and analgesia
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The Fontan operation places the systemic and pulmonary circulations in series, driven by a single ventricular chamber. It has become the treatment strategy of choice for palliating single-ventricle congenital heart disease. This anatomy engenders profound changes in physiology, affecting the cardiovascular and respiratory systems with direct implications for anesthetic and intensive care. The physical basis of these changes and their sequelae are reviewed.
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Anesthesia and analgesia · Jul 2015
ReviewA Quantitative Approach to the Intraoperative Echocardiographic Assessment of the Mitral Valve for Repair.
Intraoperative echocardiography of the mitral valve has evolved from a qualitative assessment of flow-dependent variables to quantitative geometric analyses before and after repair. In addition, 3-dimensional echocardiographic data now allow for a precise assessment of mitral valve apparatus. Complex structures, such as the mitral annulus, can be interrogated comprehensively without geometric assumptions. ⋯ Given this context, echocardiographers may be expected to diagnose and quantify valvular dysfunction, assess suitability for repair, assist in annuloplasty ring sizing, and determine the success and failure of the repair procedure. As a result, anesthesiologists have progressed from being mere service providers to participants in the decision-making process. It is therefore prudent for them to acquaint themselves with the principles of intraoperative quantitative mitral valve analysis to assist in rational and objective decision making.
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Anesthesia and analgesia · Jul 2015
ReviewPersonalizing Pediatric Pain Medicine: Using Population-Specific Pharmacogenetics, Genomics, and Other -Omics Approaches to Predict Response.
Personalized medicine is the science of individualized prevention and therapy. The notion that "one size fits all" has been replaced by the idea of patient-tailored health care. Within this paradigm, the research community has turned to examine genetic predictors of disease and treatment responses. ⋯ Simultaneously, there is an increased recognition regarding the complexity of pain research, acknowledging the additional role of epigenetic, transcriptomic, proteomic, and metabolomic factors in the development, experience, and treatment of pain. This article provides an introduction to population-specific pharmacogenetics, proteomics and other "-omics" technologies to predict drug response to pain medications in children. It aims to provide anesthesiologists with the basic knowledge to understand the potential implications of genetic and epigenetic factors managing the pain of pediatric patients.