Current opinion in anaesthesiology
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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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Toxicity concerns and awareness during anesthesia issues continue to concern pediatric anesthesiologists. Most developmental pharmacokinetic, pharmacodynamic and pharmacogenomic changes occur within the first year of life. Understanding these early changes can improve drug use in this cohort. ⋯ Mechanistic models create a framework for the study of pharmacokinetic changes in infancy. Understanding these changes allows a target concentration approach to therapy and potential for reduced toxicity. The target concentration may be undefined because of a paucity of effect measures.
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Curr Opin Anaesthesiol · Aug 2009
The risk and safety of anesthesia at remote locations: the US closed claims analysis.
A growing number of procedures are performed outside the operating room. In spite of their relatively noninvasive nature, serious adverse outcomes can occur. We analyzed claims from 1990 and later in the American Society of Anesthesiologists Closed Claims database to assess patterns of injury and liability associated with claims from anesthesia in remote locations (n = 87) compared with claims from operating room procedures (n = 3287). ⋯ Data from the American Society of Anesthesiologists, Closed Claims database suggest that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care. Similar anesthesia and monitoring standards and guidelines should be used in all anesthesia care areas.