Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2018
ReviewSedation for gastrointestinal endoscopy in Australia: what is the same and what is different?
The purpose of this article is to review the practice of sedation for adults having gastrointestinal endoscopy in Australia and to compare it with practice in other countries. ⋯ Endoscopy sedation is safe but more high-quality, multicentre observer-blinded randomized controlled trials are required.
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Curr Opin Anaesthesiol · Aug 2018
ReviewNonoperating room anesthesia for gastrointestinal endoscopic procedures.
To assess the trends in nonoperating room anesthesia (NORA) for gastrointestinal endoscopy over the past few years, and to describe alternative methods of delivering propofol sedation in selected low-risk patients. ⋯ The use of NORA for routine gastrointestinal endoscopic procedures has been rising steadily over the past decade in the United States, considerably increasing healthcare costs. Because of this, there have been attempts to develop nonanesthesiologist-administered propofol sedation methods in low-risk patients. There is controversy as to whether properly trained nonanesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation SUMMARY: The deployment of nonanesthesia-administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall healthcare costs without sacrificing sedation quality. We also address the realm of anesthesia provider care for advanced endoscopic procedures including setup for administration of anesthesia, decision-making regarding placement of an endotracheal tube, and the potential need to move a challenging case to the operating room.
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To review novel procedures in interventional radiology and describe anesthetic implications. ⋯ As the complexity of procedures and patients increases, the demand for anesthesia support in interventional radiology rises. As novel techniques are being developed, anesthesiologists must be mindful of the increased complication rate in interventional radiology and work in a multidisciplinary approach to improve patient safety.
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Curr Opin Anaesthesiol · Aug 2018
ReviewAn overview of the cannabinoid type 2 receptor system and its therapeutic potential.
This narrative review summarizes recent insights into the role of the cannabinoid type 2 (CB2) receptor as potential therapeutic target in neuropathic pain and neurodegenerative conditions. ⋯ The functional involvement of CB2 receptor in neuropathic pain and other neuroinflammatory diseases highlights the potential therapeutic role of drugs acting at the CB2 receptor.
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Curr Opin Anaesthesiol · Aug 2018
ReviewCalculations of consciousness: electroencephalography analyses to determine anesthetic depth.
Electroencephalography (EEG) was introduced into anesthesia practice in the 1990s as a tool to titrate anesthetic depth. However, limitations in current analysis techniques have called into question whether these techniques improve standard of care, or instead call for improved, more ubiquitously applicable measures to assess anesthetic transitions and depth. This review highlights emerging analytical approaches and techniques from neuroscience research that have the potential to better capture anesthetic transitions to provide better measurements of anesthetic depth. ⋯ Up-and-coming techniques have the potential to better clinically define and characterize altered consciousness time points. Such new techniques used alongside traditional measures have the potential to improve depth of anesthesia measurements and enhance an understanding of how the brain is affected by anesthetic agents. However, new measures will be needed to be tested for robustness in real-world environments and on diverse experimental protocols.