Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthetic modulation of neuroinflammation in Alzheimer's disease.
To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. ⋯ The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
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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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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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To review the recent literature on the implications of occupational radiation exposure in anesthesia practice. ⋯ Radiation is increasingly utilized in medicine for diagnostic and therapeutic procedures. Anesthesia providers may become exposed to unsafe doses while providing high-quality patient care. Understanding of the physical principles, the sources of radiation exposure, the potential risks, and safe practices helps to minimize the exposure risk and its potential deleterious effects to the anesthesia team.
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Advances in health information technology and broadband Internet connections provide novel opportunities for anesthesiologists to extend perioperative consultation services to remote geographic areas. Increasing economic pressures on healthcare delivery systems make initiatives such as telemedicine, which reduce costs while achieving excellent outcomes, an attractive option. ⋯ Anesthesiologists have the opportunity to develop telemedicine programs that can improve the delivery of care to patients. Current programs offer services ranging from remote preoperative evaluation to international collaboration for intraoperative management and consultation. Simulation using telemedicine services can provide educational opportunities and test the effectiveness of institutions' communications systems.