Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2012
ReviewPediatric dermatologic procedures performed outside the operating room.
Pediatric dermatologic procedures performed outside of the operating room are often painful and frequently require general anesthesia. Laser procedures constitute a relatively small but significant group of the growing number of these encounters. This article reviews relevant dermatological pathophysiology, current treatment modalities and collates currently available evidence to inform the best practice in anesthetic care of these patients. ⋯ Anesthesiologists are increasingly providing care for children undergoing dermatologic out-of-operating room procedures. Similar general considerations for out-of-operating room anesthesia equally apply to children undergoing these procedures. There are few recently reported data pertaining to this patient population and further work is needed.
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Curr Opin Anaesthesiol · Aug 2012
ReviewRegional anesthesia outside the operating room: indications and techniques.
Regional anesthesia is not only performed in the operating room. There are indications for the use of these techniques for pain relief in the emergency department and for anesthesia support of procedures outside the operating room. In this review, we will provide an overview of the indications for the regional techniques performed in the out-of-operating room environment. ⋯ Regional anesthesia is a valuable option for analgesia in trauma patients, enabling improved pain control in the emergency department and has benefits in the anesthetic management of therapeutic procedures outside the operating room. For many blocks, ultrasound guidance is useful.
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Curr Opin Anaesthesiol · Aug 2012
ReviewAnesthetic management of endovascular procedures for cerebrovascular atherosclerosis.
The article reviews the treatment options for cerebrovascular atherosclerosis and highlights the challenges of anesthesia in this complex group of patients. ⋯ The anesthetist plays a key role in the endovascular management of patients with cerebrovascular atherosclerosis. Optimization of comorbidities, meticulous control of systemic physiologic variables and aggressive management of complications contribute to enhanced patient outcome.
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This review will discuss the most recent developments in pharmacogenetics of commonly used perioperative medications, new collaboration networks in the field of personalized medicine, and future clinical implications of pharmacogenetics. ⋯ In the near future, pharmacogenetic approaches may facilitate personalized perioperative intervention trials.
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Curr Opin Anaesthesiol · Aug 2012
ReviewMonod-Wyman-Changeux allosteric mechanisms of action and the pharmacology of etomidate.
Formal Monod-Wyman-Changeux allosteric mechanisms have proven valuable in framing research on the mechanism of etomidate action on its major molecular targets, γ-aminobutyric acid type A (GABAA) receptors. However, the mathematical formalism of these mechanisms makes them difficult to comprehend. ⋯ Allosteric co-agonism provides a robust framework for design and interpretation of structure-function experiments aimed at understanding where and how etomidate affects its GABAA receptor target molecules.