Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2008
ReviewThe role of neurokinin-1 receptor antagonists for the management of postoperative nausea and vomiting.
To review the characteristics of neurokinin-1 receptor antagonists and their potential role in the management of postoperative nausea and vomiting. ⋯ Postoperative vomiting can lead to rare but serious complications. Neurokinin-1 receptor antagonists are significantly more efficacious against postoperative vomiting than other antiemetics. Because the benefit in terms of absolute risk reduction is critically dependent on the patient's baseline risk, it is recommended to use a validated risk score to identify patients who will benefit most from prophylaxis using neurokinin-1 receptor antagonists.
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Curr Opin Anaesthesiol · Aug 2008
ReviewRecent advancements in the treatment of lumbar radicular pain.
Lumbar radicular pain is a common and often difficult condition to treat. Current literature supports the theory that radicular pain is at least in part due to an inflammatory process involving cytokines, including tumor necrosis factor alpha and interleukins. This review summarizes some of the most recent research concerning the use of tumor necrosis factor alpha antagonists and interleukin receptor antagonists in the treatment of lumbar radicular pain. ⋯ Treatment for lumbar radicular pain has long included epidural steroids to inhibit the inflammatory component of radicular pain. Recent studies have more precisely identified the cytokines responsible for this inflammatory process and indicate that inhibition of these cytokines may offer more specific and effective treatment for lumbar radicular pain.
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The demand of procedures performed on children outside the operating room setting often exceeds the capacity of anesthesia services. The number of children requiring sedation outside the traditional operating room is rapidly approaching the number of children requiring anesthesia in the operating room. We address some of the major issues and controversies in this continuously evolving field. ⋯ A standard approach (adequate preparation, clinical assessment of the child, fasting as required and right sedation plan) is mandatory to provide safety and efficiency. Sedation is a continuum, and it can be easy to advance from one level to the next and even reach a state of general anesthesia. Newer modalities such as end-tidal CO2 and, maybe, bispectral index monitoring are indeed enhancing the safety of procedural sedation and analgesia.