Current opinion in anaesthesiology
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Opioid administration is a mainstay of anesthetic practice both for treating acute perioperative pain and for chronic pain syndromes. Growing pharmacogenetic data make it evident that many opiate-related phenomena are influenced by genetics. Genetic variation may significantly affect opiate absorption, distribution, metabolism, excretion and toxicity. We provide a current review of opiate pharmacogenetics. ⋯ Knowledge of genetic factors that affect opioid efficacy, metabolism, and side effects have the potential for personalizing both acute and chronic pain management, and for designing more effective opiate pain medications with lower side effect profiles.
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Inhalational anaesthetic agents are a cornerstone in modern anaesthetic practice. The currently used compounds are very effective and have a good safety profile. In addition, it has been demonstrated that they possess organ-protective properties that might provide an additional tool in the treatment or prevention of the consequences of organ ischaemia-reperfusion injury or both. The present review summarizes some of the most recent findings on this subject. ⋯ In the experimental setting, inhalational anaesthetics have protective effects against ischaemia-reperfusion injury. Initial perioperative data suggest that these effects may also result into clinically relevant improved organ function. However, further research will be needed to reveal whether these organ-protective properties will ultimately translate into an improved short-term and long-term postoperative outcome.
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Safety, quality, and patient satisfaction are not only defined by the incidences of serious adverse events but also include postoperative outcomes such as postdischarge nausea and vomiting (PDNV). PDNV has a high impact on patient recovery and may influence the cost-effectiveness of office-based surgical procedures. This article reviews the incidences and risk factors for PDNV as well as medications and concepts for prophylaxis and treatment. ⋯ PDNV is an under-recognized problem after outpatient anesthesia. Valid data for the incidence and the best treatment of PDNV after office-based anesthesia are rare. For safety, quality, and patient satisfaction, further research is needed to develop a prediction model to better identify patients at risk for PDNV in order to direct antiemetic prophylaxis for ambulatory patients undergoing office-based anesthesia.
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To present recent experiences and studies on the pharmacologic profile of levosimendan in the context of surgery, anesthesia and critical care. Special emphasis is on the studies that could support the use of or create novel indications for levosimendan in these patients. ⋯ New practice advisories and proposals for indications to treat and prevent low-output syndrome in patients at risk are warranted for patients undergoing cardiac surgery with cardiopulmonary bypass. Levosimendan should also be considered as an adjunct drug for the treatment of cardiogenic shock. Further experience and controlled studies are needed to support the use of levosimendan for other perturbations in critical care and perioperative medicine.