Current opinion in anaesthesiology
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Pharmacology is one of the corner stones of anesthesia. Outcome of anesthesia is related, in part, to both pharmacodynamics and pharmacokinetics of anesthetic drugs. Recent developments have indicated that among individuals, major differences exist in pharmacological effects. In this regard, sex, age, and genetic profile are increasingly considered to be of importance. ⋯ In the future, it is expected that an individual's pharmacological needs will be based on age, sex, and genomics.
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Curr Opin Anaesthesiol · Aug 2008
ReviewPerioperative management including new pharmacological vistas for patients with pulmonary hypertension for noncardiac surgery.
Pulmonary hypertension is a condition that has a multitude of causes. Left untreated, patients with pulmonary hypertension will experience progressive symptoms of dyspnea and right heart failure resulting in significant morbidity and mortality. This review details the many evolving aspects of understanding related to pulmonary hypertension including signs and symptoms, pathophysiology, classification, anesthetic management including perioperative considerations and treatment options. ⋯ Coupled with aggressive use of improved diagnostic hemodynamic monitors perioperatively, these patients can be medically optimized during their hospitalization and possibly aid in improving their long-term prognosis.
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To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. ⋯ Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.
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Curr Opin Anaesthesiol · Aug 2008
ReviewAnesthesia outside the operating room in the office-based setting.
The majority of anesthesia services provided outside the operating room or ambulatory surgery center is in the office-based setting. This review will focus on three areas that are critical to office-based anesthesia: safety, quality of care and patient satisfaction. ⋯ There is rapid growth for the need of safe and high quality office-based anesthesia. To meet these needs, a special set of skills is required, which may require expanded exposure and experience during training. An office-based anesthesia central data repository is needed for benchmarking and identifying areas for improvement. Finally, with advances in surgical technology, there is a need for focused research in office-based anesthetic techniques and modalities and patient satisfaction.
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The purpose of the present review is to focus on the literature in the past year and specifically the development of recent guidelines, the debate on who does the sedation anaesthesia for MRI in a paediatric patient, the use of medications and techniques, and the use of monitors and equipment. ⋯ The MRI suite is a challenging environment for anaesthetists and nonanaesthetists, and has serious risks. A systematic approach, similar to that of anaesthesia provided in the operating room, is mandatory. A well equipped anaesthesia machine, standard monitoring, trained personnel and adequate planning should be standard for all procedures out of the operating room.