Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2019
ReviewAnesthesia and analgesia for transvaginal oocyte retrieval. Should we recommend or avoid any anesthetic drug or technique?
The objective of this review is to analyze and summarize the current anesthetic methods used to alleviate pain and discomfort during transvaginal oocyte retrieval procedures (TORP), to try to reach practical recommendations, based on the evidence, which will translate into daily practice, the knowledge on the anesthetic management of patients scheduled for TORP. ⋯ TORP is painful for women and different techniques may be used for pain relief in day case surgery. The other important outcome to consider is the pregnancy rate, and any anesthetic technique or drug which would improve this pregnancy rate should be recommended. Conscious sedation and general anesthesia proved to be well tolerated for woman and the oocytes, despite the use of propofol, opioids, benzodiacepines, nitrous oxide, or other drugs. Spinal anesthesia and paracervical block are also acceptable options, and can be combined with conscious sedation. Nevertheless, more studies are needed to find out the ideal drug or technique combination for the woman and the oocyte.
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Curr Opin Anaesthesiol · Jun 2019
ReviewPharmacokinetic-pharmacodynamic population modelling in paediatric anaesthesia and its clinical translation.
Pharmacokinetic-pharmacodynamic (PKPD) population modelling has advanced adult anaesthesia. Current literature was reviewed to discern use of this analytic technique for benefit in the perioperative management of children. ⋯ Modelling and simulation continue to have an important role optimizing drug use during anaesthesia. Models incorporating influential covariates that better describe drug pharmacokinetics and pharmacodynamics improve anaesthetic treatments and safety in diverse populations and clarify drug role and impact. Their use developing paediatric clinical studies improves trial conduct, often with fewer subjects required for study.
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Curr Opin Anaesthesiol · Jun 2019
ReviewAnaesthetic neuroprotection in children: does it exist or is it all just bad?
In the last 20 years, data from studies of laboratory animals, including nonhuman primates, have provided ample evidence that general anaesthetic drugs cause pathological changes in developing central nervous system (neurotoxicity). Recently, a new area of research has been developed in order to recognize any possible actions that can attenuate anaesthetics neurotoxicity. This review aims to provide an overview of the recent literature on neuroprotection. ⋯ Recent literature largely explores a variety of solutions in order to preserve and reduce the damage caused by anaesthetic agents. At the moment, none of the presented solutions regarding neuroprotection is applicable in clinical setting. Further research studies are needed.
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Curr Opin Anaesthesiol · Jun 2019
ReviewThe patient with hypertension and new guidelines for therapy.
Hypertension is a leading disease in preoperative clinics; nearly 60% of patients over 60 years have it. Many guidelines have been published for the diagnosis and treatment of hypertension. Last year, the American College of Cardiology/American Heart Association and European Society of Cardiology and European Society of Hypertension made new recommendations for diagnosis and management, with special emphasis on targets, nonpharmacological treatment, and management of the elderly patient, and pharmacological therapy. We will review relevant concordances and differences that are important for the anesthesiologist and perioperative management. ⋯ New guidelines could increase the burden of patients with pharmacological treatment that will need surgery and require case by case considerations. The scarcity of information demands trials about blood pressure management and consensus about antihypertensive medications in perioperative period.
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With new medical technologies and changing life styles, maternal demographics has changes and consequently older and sicker women are becoming pregnant.In this review, we present these different high-risk parturient populations, which were once considered rare for the practicing obstetric anesthesiologist. ⋯ Future research and implementation of international guidelines for management of these high-risk parturient population is necessary in order to reduce maternal and neonatal morbidity.