Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2016
ReviewPractical considerations in the management of sedation for colonoscopy.
The purpose of this review is to discuss the unique elements of providing anesthesia services for colonoscopy including the practical issues within an endoscopy suite, nothing by mouth status for colonoscopy, chronic medication instructions, appropriate anesthesia equipment, informed consent, pharmacology of agents for sedation, anesthetic techniques, and issues related to postprocedural care. ⋯ Sedation for colonoscopy is a rapidly expanding subspecialty with special needs created by the increasing medical complexity of the patients, the demands of the endoscopy procedures, the challenges of the endoscopy suite, and the rapid turnover of the outpatient environment.
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Curr Opin Anaesthesiol · Aug 2016
ReviewEducation and training for nonanesthesia providers performing deep sedation.
There has been a significant increase in the number and types of procedures performed outside of the operating room with nonanesthesia providers administering sedation. This review describes current recommendations for training nonanesthesiologists involved in administering deep sedation, summarizes best practices and highlights select patient outcomes. ⋯ The American Society of Anesthesiologists publishes recommendations regarding the essential educational components for nonanesthesiologist providers who administer deep sedation. The available data support the need for formal educational programmes to prevent adverse events associated with deep sedation. Competencies should include preprocedural evaluation, understanding sedation levels, airway management, documentation, emergency life support skills, teamwork and quality improvement.
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Curr Opin Anaesthesiol · Aug 2016
ReviewOpioids and tumour metastasis: does the choice of the anesthetic-analgesic technique influence outcome after cancer surgery?
Cancer is now one of the leading causes of death worldwide, and excisional surgery is an essential treatment for the four most common adult cancers. Opioids remain the most commonly prescribed analgesics in the perioperative period of cancer surgery, yet the question of whether opioids could influence recurrence or metastasis remains unanswered. ⋯ Prospective randomized trials are required to investigate this important topic further. Several are currently ongoing. Until the results of these are available for scrutiny, there is currently insufficient evidence to recommend any changes to current clinical practice. Opioids continue to play an important role in the perioperative period.
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Anesthesia for dentistry is commonly performed outside the operating room. The combination of a shared airway between surgeon and anesthetist, the variety of open airway techniques, and the out-of-operating room setting often results in anxiety and avoidance of dental cases among anesthesia personnel. This review attempts to demystify dental treatment and facilitate the anesthesia provider in providing effective sedation of dental procedures performed in the nonoperating room setting. ⋯ This article reviews the indications, facility and equipment needs, monitoring requirements, treatment methods, and recovery protocols necessary for the safe administration of off-floor anesthesia for dentistry.
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Curr Opin Anaesthesiol · Aug 2016
ReviewNew insights in the systemic and molecular underpinnings of general anesthetic actions mediated by γ-aminobutyric acid A receptors.
The review highlights novel insights into the role of γ-aminobutyric acid A (GABAA) receptors in mediating clinically relevant actions of anesthetic agents. ⋯ Identification of the molecular and cellular substrates involved in anesthesia and insights into disease and drug-induced alterations in the expression patterns of GABAA receptors in the central nervous system are emphasizing the need for individualized anesthesia care. Introducing neuroactive steroids into clinical anesthesia is expected to reduce cardiovascular and respiratory side-effects.