Current opinion in anaesthesiology
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This review summarizes the current anesthetic management of patients undergoing craniotomies in the awake state. ⋯ A safe and acceptable analgesic/amnestic state for these procedures can be provided by the use of dexmedetomidine, with or without the addition of remifentanil.
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Curr Opin Anaesthesiol · Aug 2007
ReviewCorrelating the clinical actions and molecular mechanisms of general anesthetics.
To summarize recent in-vitro and in-vivo research on molecular mechanisms of general anesthetics' actions. ⋯ Several clinically distinct 'anesthetic states' are induced by different classes of drugs acting on neuronal circuits via different molecular targets. Understanding the mechanisms underlying the therapeutic and toxic actions of general anesthetics helps us reframe the 'art' of anesthesia into more of a 'science'. These studies also enhance efforts to develop new drugs with improved clinical utility.
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The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic. ⋯ The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.
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Paravertebral blocks are becoming increasingly popular, especially as an anesthetic adjunct for breast procedures. New reports suggest additional reasons for adding this block to the anesthetic armamentarium. ⋯ Paravertebral blocks are a well established option to provide anesthesia and postoperative analgesia during breast surgery. Recent studies suggest additional benefits to this procedure. Not only is acute pain better controlled, but the development of chronic mastectomy pain syndrome and recurrence of cancer may be reduced by preoperative placement of paravertebral block. These studies provide additional reasons why this block should be considered as part of the anesthetic for breast surgery.
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Curr Opin Anaesthesiol · Aug 2007
ReviewNon-anesthesiologist-provided pediatric procedural sedation: an update.
This review evaluates the past year's literature on the provision of pediatric procedural sedation outside of the operating room, especially as performed by non-anesthesiologist healthcare providers. ⋯ Pediatric procedural sedation practice as performed by non-anesthesiologists continues to grow. Ongoing efforts to understand the elements of sedation systems that lead to best practice, with the subsequent development of uniform practice approaches, are essential. A collaborative relationship between anesthesiologists and non-anesthesiologist providers of procedural sedation is essential for meeting common goals.