Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2006
ReviewAlveolar recruitment versus hyperinflation: A balancing act.
To address lung recruitment according to pressure/volume curves, along with regional recruitment versus hyperinflation evidence from computed tomography and electrical impedance tomography. ⋯ Positive end-expiratory pressure levels must be high enough to minimize recruitment/derecruitment cycling. Balancing recruitment versus overdistension may require thoracic tomography, to assure sufficient improvement in oxygenation while limiting hypercarbia.
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Obese patients are more and more frequently proposed for elective surgery, including acts specifically aimed at curing this condition, i.e. bariatric surgery. Many of these acts present characteristics compatible with ambulatory treatment, but anesthesiologists are reluctant to treat the morbidly obese as outpatients due to lack of data on the safety of this approach. The purpose of this review is to present the information that could be found in the literature on the safety and feasibility of ambulatory procedures in obese patients, and outline the specificity of this population. ⋯ Ambulatory care in the obese patient is both feasible and well suited to this population provided a few specificities are taken into account.
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An increasing number of day-case surgical patients is challenging the presently used methods of anaesthesia: reliable surgical anaesthesia should be fast, with rapid recovery and minimal side effects. To compete with modern ambulatory general anaesthesia a knowledge of special spinal anaesthesia techniques is essential. This review brings together important issues concerning the spinal technique, anaesthetic agents and benefits as well as the disadvantages of spinal anaesthesia in outpatients. ⋯ To produce reliable spinal anaesthesia with a reasonable recovery time it is essential to understand the factors affecting the spread of spinal block and to choose the optimal drug and adequate dose for specific surgical procedures.
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Curr Opin Anaesthesiol · Dec 2006
ReviewPharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting.
The use of selective 5-hydroxytryptamine type 3 receptor antagonists has improved the management of postoperative nausea and vomiting, but has not completely eliminated it. In this article, we discuss the pharmacology of 5-hydroxytryptamine type 3 receptor antagonists and the impact of pharmacogenetics on postoperative nausea and vomiting. ⋯ Pharmacogenetics testing in patients may help differentiate responders to 5-hydroxytryptamine type 3 receptor antagonists from non-responders and allow the anesthesiologist to individualize antiemetic therapy. The cost-effectiveness of such screening in postoperative nausea and vomiting management has, however, not been evaluated. Given the multifactorial nature of postoperative nausea and vomiting, a multimodal approach to reduce or eliminate risk factors will be most successful in its management.
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Curr Opin Anaesthesiol · Dec 2006
ReviewNitrous oxide in ambulatory anaesthesia: does it have a place in day surgical anaesthesia or is it just a threat for personnel and the global environment?
Nitrous oxide is by far the oldest anaesthetic still in routine use and its continued use is often questioned. Nitrous oxide is toxic with prolonged exposure, can damage the environment, causes pressure effects through expansion of closed air-filled spaces and has long been suspected of being harmful following chronic exposure to trace concentrations. What could possibly justify the continuing use of nitrous oxide? ⋯ Not only is nitrous oxide almost certainly less hazardous than is sometimes perceived, it has numerous benefits which are not easily replicated by possible alternatives. In particular, its use improves the quality and safety of induction and maintenance of anaesthesia and facilitates faster recovery with minimal adverse effects. All of these benefits are achieved while at the same time reducing overall costs. With few significant drawbacks and numerous advantages, there appears still to be a valuable place for nitrous oxide in modern ambulatory anaesthesia.