Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2012
ReviewThe current status of procedural sedation for pediatric patients in out-of-operating room locations.
To illustrate the changes that are occurring in the rapidly growing field of pediatric sedation. In the USA and throughout the world, children receive sedation from a multitude of specialists with varying levels of training. The current pediatric sedation literature reflects a growing body of sedation literature by medical specialists other than anesthesiologists. This article will review the controversial use of propofol by nonanesthesiologists and the manner in which this varied group of providers along with government entities, regulatory agencies, and national organizations contribute to the continuing evolution of sedation practices. ⋯ The direction of pediatric sedation is no longer solely under the leadership of anesthesiologists. The use of anesthetic agents, including propofol, have been administered by nonanesthesiologists and reported as safe and effective agents. Nonanesthesiologists and governmental and regulatory agencies influence the delivery of sedation services. The future direction of pediatric sedation will ultimately depend upon the ability of anesthesiologists to collaborate with specialists, hospital administrators, credentialing committees, and oversight agencies in order to provide high-quality efficient sedation services to children.
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Curr Opin Anaesthesiol · Aug 2012
ReviewFundamental concepts of epigenetics for consideration in anesthesiology.
Epigenetics dictate how the genetic blueprint is ultimately expressed and, therefore, is fundamental to our understanding of disease etiology and cellular responses and consequences to exposure of stimuli, such as anesthetics and perioperative stress. The goal of this review is to provide a concise overview of the fundamental concepts in epigenetics and discuss how epigenetics may be incorporated into research studies in anesthesiology. ⋯ Epigenetic mechanisms underlie many human pathological conditions and impact clinical management in a variety of contexts. Although epigenetic research related to anesthesiology is sparse at the present, the full understanding of the mechanism of action of analgesics, interindividual variations in responses to anesthetics and consequences of exposure to anesthetic drugs will likely require the evaluation and integration of epigenetic information into current research paradigms.
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Curr Opin Anaesthesiol · Aug 2012
ReviewAnesthetic management of children undergoing hematologic-oncologic procedures outside the operating room.
There is an increasing demand on anesthetic services to provide care for children undergoing hematologic-oncologic procedures outside the operation room; in particular, to mitigate the pain and unpleasant side-effects of these treatments. This review provides an update of the latest findings on this topic. ⋯ Treatment of children undergoing hematologic-oncologic procedures outside the operation room is challenging. Expertise and high standards are essential to assure patient safety.
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Can a general anesthetic binding to its membrane receptors alter global brain activity to cause loss of consciousness? ⋯ An important feature of general anesthesia is a preferential inhibition of global feedback connectivity when general anesthetics bind to allosteric sites of gamma-aminobutyric acid receptors present in the cerebral cortex.
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Cardiac arrhythmias are a major source of morbidity and mortality. Many of these patients require diagnostic or therapeutic intervention in an electrophysiology laboratory with involvement of an anesthesiologist. The goal of this review is to provide the anesthesiologist with a comprehensive understanding of the mechanisms underlying various arrhythmias; specific procedures performed for diagnosis and treatment, and associated risks. ⋯ By reviewing the current literature regarding electrophysiology procedures, this review will provide information essential to the anesthesiologist to safely care for this unique patient population.