Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthesia and the developing brain: are we getting closer to understanding the truth?
Due to increased frequency of surgical interventions, infants and young children are exposed to anesthesia, often repeatedly, during an extremely delicate period of brain development. We review new evidence that continues to challenge the safety of this practice. ⋯ Although clinical importance remains to be substantiated, results to date do indicate that exposure of animals to general anesthesia during active synaptogenesis is most detrimental. Accordingly, it is essential to determine when synaptogenesis begins and ends in developing humans. It is also imperative that effective preventive techniques be developed so that existing anesthetics can be used with minimum risk of neurotoxic side-effects of anesthesia.
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Curr Opin Anaesthesiol · Aug 2011
ReviewLinking inflammation and coagulation: novel drug targets to treat organ ischemia.
Activation of the coagulation system during ischemia/reperfusion injury is an unavoidable event and even further augmented during cardiovascular surgery. Clotting not only leads to disturbance of blood rheology but also enhances the inflammatory response. We aim to highlight the inflammatory properties of the coagulation system and novel potential therapeutic approaches targeting both features. ⋯ Ischemia and reperfusion are common activators of coagulation that is also accompanied by inflammation. Therefore, targeting this well orchestrated system might be of therapeutic benefit, as its mode of action is dual: clotting inhibition and anti-inflammation. This novel therapeutic approach might at least be of benefit in the treatment of systemic inflammatory syndromes following, that is, cardiovascular surgery.
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Curr Opin Anaesthesiol · Aug 2011
ReviewNutritional pharmacology in surgery and critical care: 'you must unlearn what you have learned'.
This review highlights the rapidly evolving field of 'pharmaconutrition' by discussing the mechanistic and clinical data for calorie delivery and nutrients shown to improve outcome in surgical and ICU care. ⋯ We believe the future of surgical and ICU nutrition will involve administering specific pharmaconutrients as separate components, much like drugs are given. The current use of clinical pharmacology, molecular biology, and clinical research principles in the study of pharmaconutrients should yield answers on how to administer the right nutrients, in the right doses, at the right time in sick patients.
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Curr Opin Anaesthesiol · Aug 2011
Review Comparative StudyA brief comparison of the pathophysiology of inflammatory versus neuropathic pain.
The causes of inflammatory pain and neuropathic pain are fundamentally different. There are, however, common mechanisms underlying the generation of each pain state. We will discuss some specific elements observed in both tissue and nerve injury pain states and consider the hypothesis that these two states actually demonstrate a convergence over time. ⋯ Recognition of mechanisms common to both inflammatory pain and neuropathic pain might shed light on the understanding of the transition from acute pain to persistent pain.