Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2010
ReviewNear infrared spectroscopy in children at high risk of low perfusion.
Tissue oximetry has been suggested as a noninvasive tool to continuously monitor and detect states of low body perfusion. This review summarizes recent developments and available data on the use of near infrared spectroscopy (NIRS) in children at risk for low perfusion. ⋯ Despite shortcomings in the ability of NIRS technology to accurately reflect validated and directly measured parameters of systemic oxygen delivery and blood flow, NIRS can certainly assist in the detection of low-flow states (low cardiac output). Large, randomized, prospective studies with well defined outcome parameters are still missing and warranted in order to clearly define the role of NIRS in children at risk for low perfusion.
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There is an emerging epidemic of obesity worldwide resulting in a greater number of obese patients presenting for surgery. The combined problems of metabolic disease and mechanical impairment from excess tissues present a variety of problems for the anesthesiologist. ⋯ Current studies have focused on the immediate impact of obesity on anesthesia and postoperative care. Future research will focus primarily on perioperative metabolic optimization.
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Curr Opin Anaesthesiol · Jun 2010
ReviewIs there any relationship between long-term behavior disturbance and early exposure to anesthesia?
There is now more than a decade of mounting animal data that anesthetic drugs can cause apoptosis during a critical period of brain development and that this correlates with later behavioral disturbances. Initial articles examining the effects of early anesthesia on human infants have recently been published. Prospective studies are underway. ⋯ Although the evidence from animal studies is clear and continuing to mount that anesthetic drugs given at the right time and in sufficiently high and prolonged doses do cause increased neuronal apoptosis and later problems with learning, evidence in humans that this is of clinical concern is both weak and mixed. Additional studies are ongoing to try to better define the risk.
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Curr Opin Anaesthesiol · Jun 2010
ReviewCan inhalation agents be used in the presence of a child with myopathy?
Anaesthesia for a child with a muscle disease is always challenging because there is a risk of malignant hyperthermia, rhabdomyolysis or hypermetabolic reaction if a halogenated agent is used. Ongoing progress in genetics helps in clarifying the link between malignant hyperthermia (a calcium channelopathy) and muscle diseases. ⋯ Only a few muscle diseases are really associated with a risk of malignant hyperthermia. The risk of rhabdomyolysis is more difficult to clarify and a multicentric database would be useful to evaluate the risk/benefit ratio of all anaesthetic drugs in patients with muscle diseases.
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Curr Opin Anaesthesiol · Jun 2010
ReviewAnesthesia for patients with a history of malignant hyperthermia.
Malignant hyperthermia-susceptible patients have an increased risk during anaesthesia. The aim of this review is to present current knowledge about pathophysiology and triggers of malignant hyperthermia as well as concepts for safe anaesthesiological management of these patients. ⋯ The incidence of malignant hyperthermia is low, but the prevalence can be estimated as up to 1: 3000. Because malignant hyperthermia is potentially lethal, it is relevant to establish management concepts for perioperative care in susceptible patients. This includes preoperative genetic and in-vitro contracture testing, preparation of the anaesthetic workstation, use of nontriggering anaesthetics, adequate monitoring, availability of sufficient quantities of dantrolene and appropriate postoperative care. Taking these items into account, anaesthesia can be safely performed in susceptible patients.