Current opinion in anaesthesiology
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The choice of local anesthetics in regional anesthesia depends on desired onset, intensity, and duration of block, as well as possible adverse effects. This review highlights recent advances in day-case spinal anesthesia; considerations in selecting local anesthetic volume, concentration, and mass in peripheral nerve blockade; and the pharmacokinetics of ropivacaine. ⋯ There are effective alternatives to bupivacaine in day-case spinal anesthesia but more safety and outcome data are required, particularly for 2-chloroprocaine. The trend toward smaller doses of local anesthetics in ultrasound-guided regional anesthesia improves safety but should be weighed against possible reductions in speed of onset and analgesic duration. Strategies to reduce the risk of local anesthetic systemic toxicity should be employed when performing large-volume fascial plane blocks with ropivacaine.
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Curr Opin Anaesthesiol · Aug 2014
ReviewDelirium and sleep disturbances in the intensive care unit: can we do better?
Delirium in the ICU affects as many as 60-80% of mechanically ventilated patients and a smaller but substantial percentage of other critically ill patients. Poor sleep quality has been consistently observed in critically ill patients. These problems are associated with worse ICU outcomes and, in many cases, delirium and poor sleep quality may be related. This review will summarize the recent literature relevant to both the problems and provide a potential pathway toward improvement. ⋯ It is our responsibility to apply the best available, evidence-based medicine to our practice. Adherence to new guidelines for the treatment of pain, agitation, and delirium may be the best pathway toward reducing delirium, improving sleep quality, and improving related outcomes.
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To discuss the recent advances in sedation and anesthesia for the practice of both flexible and rigid bronchoscopy, which are increasingly performed outside of the operating room by interventional pulmonologists and thoracic surgeons. ⋯ As our practice expands, relocation of appropriately triaged pulmonary interventional procedures including rigid bronchoscopy that were previously assigned to a traditional operating room setting improves provider flexibility, presents more cost-effective options while maintaining patient safety and satisfaction and reducing the time to recovery. Anesthesia practice has, therefore, shifted to caring for these sick patients outside the operating room and increasingly cooperation between anesthesiologist and proceduralist is required.
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Curr Opin Anaesthesiol · Aug 2014
ReviewRole of novel drugs in sedation outside the operating room: dexmedetomidine, ketamine and remifentanil.
Progress in medical technology, diagnostic procedures and imaging techniques results in a growing demand for well tolerated sedation regimens, devoid of respiratory and haemodynamic complications. Moreover, rapid turnover time dictates the need for rapid onset of effect and rapid recovery. Recent literature regarding the use of dexmedetomidine, ketamine and remifentanil for sedation outside the operating room is reviewed. As procedural sedation is often performed by nonanaesthesiologists, articles from journals other than anaesthesiology journals are also included. ⋯ Recent literature is reviewed regarding dexmedetomidine, ketamine and remifentanil for its use outside the operating room. Sedationists have to keep in mind the pharmacokinetics and pharmacodynamics of the currently used agents in adults and children.