Current opinion in anaesthesiology
-
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.
-
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.
-
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.
-
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.
-
Sugammadex is a novel drug that binds selected neuromuscular blocking drugs and prevents them from acting at the neuromuscular junction. Due to its rapid onset and relative lack of side effects, this drug promises to change the method of anesthesia delivery. This review summarizes the literature on the drug and addresses some of the potential changes that it may bring. ⋯ Sugammadex binds neuromuscular blocking drugs and encapsulates them, making cholinesterase inhibitors unnecessary. Its rapid reversal of blockade makes it possible to keep patients profoundly muscle relaxed until drapes come down and it can enable a rapid return to spontaneous ventilation in a 'cannot intubate, cannot ventilate' situation. Costs and date of availability have yet to be determined.