Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2005
Anaesthetics and the rate corrected interval: learning from droperidol?
Understanding of the long QT syndrome continues to evolve. Anaesthesia in patients with untreated long QT syndrome carries a risk of perioperative malignant ventricular arrhythmias. Genotypically susceptible individuals may have a normal rate-corrected QT interval and present with torsade de pointes intraoperatively. The likelihood of arrhythmias can be reduced by careful preoperative preparation. Perioperative disturbances in physiological homeostasis and drugs administered can prolong the rate-corrected QT interval. ⋯ Droperidol can lead to serious cardiac arrhythmias from QT prolongation. Recent advances in the pathophysiology of congenital and acquired long QT syndrome are reviewed. Preclinical tests assessing potential new drugs for QT prolongation are briefly discussed. Considerations for the management of these patients during perioperative phases are explored. The optimal treatment of the long QT syndrome is presented along with a glimpse into future possibilities in this field.
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Curr Opin Anaesthesiol · Aug 2005
Molecular and systemic mechanisms of general anaesthesia: the 'multi-site and multiple mechanisms' concept.
Amnesia, hypnosis and immobility are essential components of general anaesthesia. This review highlights recent advances in our understanding of how these components are achieved at a molecular level. ⋯ Clinical anaesthesia is based on drug actions at multiple anatomical sites in the brain. The finding that amnesia, hypnosis and immobility involve distinct molecular targets opens new avenues for developing improved therapeutic strategies in anaesthesia.