Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
ReviewSedation and anesthesia for the pediatric patient undergoing radiation therapy.
Radiation oncology is a cornerstone in the treatment of cancer in children. Although painless, there is a requirement for the child to lie still by themselves in the radiation treatment room, for multiple daily or twice daily treatments for up to 6 weeks. Anesthesia or sedation is usually necessary to achieve this in younger children. This review provides a brief update of the latest developments in radiation oncology and describes the current best practice in anesthesia for these children. ⋯ In the vast majority of cases, total intravenous anesthesia or sedation using propofol ensures that the child remains immobile, whilst maintaining spontaneous respiration, an unobstructed airway, and cardiovascular stability.
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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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Since the detection of morphine by the pharmacologist Friedrich Sertürner in 1806, opioids have been used as potent centrally acting analgesics. In addition to the central site of action, peripheral endogenous opioid analgesic systems have been extensively studied, especially in the past two decades. This review is not only mentioned to give a brief summary in this well investigated field of peripheral opioid receptors, but also to highlight the role of peripheral opioid receptors in other physiological and pathophysiological conditions. ⋯ Efforts continue to develop opioid analgesics unable to cross the blood-brain barrier, which act only peripherally in low doses, thus providing adequate analgesia without central and systemic side-effects.The awareness of the influence of peripheral opioid receptors beyond nociception may also have therapeutic ramifications on the other fields mentioned above. For example, the treatment of opioid-induced bowel dysfunction by methylnaltrexone is one of the major findings in the previous years.
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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.