Current opinion in anaesthesiology
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The present review serves as an overview update in the diverse uses of the sedative dexmedetomidine. ⋯ Dexmedetomidine is a useful medication with many clinical applications. The medication has shown efficacy in decreasing the need for opioids, benzodiazepines, propofol, and other sedative medications. Short-term sedation has been shown to be safe in studies, although hypotension and bradycardia are the most significant side effects. Dexmedetomidine has been used effectively for sedation during pediatric procedures and in the ICU. In order to reduce sympathetic tone during cardiac surgery, a low-dose dexmedetomidine infusion has been utilized. The bariatric surgery population has also been studied with dexmedetomidine because of its adequate sedation and less prevalent respiratory depression when compared with opioid administration. Dexmedetomidine is emerging as an effective therapeutic agent in the management of a wide range of clinical conditions with an efficacious, safe profile.
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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
ReviewPharmacology of cyclooxygenase-2 inhibitors and preemptive analgesia in acute pain management.
NSAIDs have served as analgesic, antiinflammatory, and antipyretic medicines for over a century. A novel class of NSAIDs, cyclooxygenase-2 inhibitors, was introduced in 1999. All NSAIDs and aspirin inhibit active sites of cyclooxygenase-1 and cyclooxygenase-2. Recent studies have demonstrated an important role of cyclooxygenase-2 inhibitors in the management of acute pain processes. ⋯ On the basis of many human studies, one may conclude that perioperative cyclooxygenase-2 inhibitors, in standard doses, decrease opioid consumption. Future investigations that include different multimodal techniques, for example combining cyclooxygenase-2 inhibitors with regional blocks, may help elucidate and clarify the true benefits of perioperative cyclooxygenase-2 inhibitors in acute pain management strategies.
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Diagnostic and therapeutic endovascular stenting tended to expand in the last decade. The anesthetist may be asked to participate in the management of these patients with severe associated comorbidities complicating the delivery of anesthesia. This review describes current vascular stentings performed in the radiology suite and their relevant consequences interesting the anesthetist. ⋯ Literature review provides little information about anesthetic management of extracranial endovascular stentings. Knowledge of indication and consequences is mandatory for anesthetists in charge of these patients.