Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2009
ReviewRisk and safety of pediatric sedation/anesthesia for procedures outside the operating room.
Sedation and anesthesia outside the operating room represents a rapidly growing field of practice that involves a number of different specialty providers including anesthesiology. The literature surrounding this work is found in a variety of journals - many outside anesthesiology. This review is intended to inform readers about the current status of risk and safety involving sedation/anesthesia for tests and minor procedures utilizing a wide range of sources. ⋯ The latest publications continue to document a relatively low risk to pediatric sedation yet also warn us about the potential adverse events in this field. The results help to define competencies required to deliver pediatric sedation and make this practice even safer. Particularly interesting are new jargon and methodologies for defining adverse events and the use of new methods for training sedation providers.
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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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We review the efficacy and safety of gantacurium and AV002, two novel, investigational fumarate-based nondepolarizing neuromuscular blockers, as well as sugammadex and cysteine, two novel reversal drugs that have no acetylcholinesterase inhibition properties. ⋯ In a multicenter phase-2 randomized controlled study in the European Union, the efficacy and safety of gantacurium were evaluated, but results have not yet been published. Sugammadex is currently available in the European Union, but the United States Food and Drug Administration has had concerns about its safety (hypersensitivity and allergic reactions) and has asked for additional safety data. It is hoped that the widespread use of sugammadex in the European Union will provide additional information.
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Curr Opin Anaesthesiol · Aug 2009
ReviewPharmacokinetic-pharmacodynamic modeling in anesthesia, intensive care and pain medicine.
Studies from the anesthesiology literature published in the last 2 years were selected to illustrate the most important developments in the field of pharmacokinetic-pharmacodynamic modeling. ⋯ Progress was made by improving population pharmacokinetic/pharmacodynamic models, developing new indexes to measure drug effect and using them in an adaptive delivery system to the individual patient.
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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.