Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthetic management of transcatheter aortic valve implantation.
The revolution in transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis has been well described by the large number of randomized trials, registries, and single and multicenter experiences published during 2010-2011. The aim of this review is to describe the challenges of the anesthetic management related to TAVI. ⋯ Preprocedural, multidisciplinary assessment of the patient is essential prior to TAVI and should include a full anesthetic evaluation, consideration of patient comorbidities, and determination of technical feasibility. The role of scoring systems for risk prediction requires further scrutiny. Multidevice/multiple access approaches allow for treatment of a wide range of patients. Anesthetic techniques and supportive measures vary depending on procedural concerns, patient comorbidity, and severe, often unstable cardiac disease. Echocardiography is fundamental to preoperative evaluation, procedure guidance, and assessment of complications. Planned bailout strategies should be discussed with all members of the medical team. Postoperative standardized monitoring and management protocols are essential.
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Curr Opin Anaesthesiol · Aug 2011
ReviewAnesthetic modulation of neuroinflammation in Alzheimer's disease.
To summarize key studies and recent thought on the role of neuroinflammation in chronic neurodegeneration, and whether it can be modulated by anesthesia and surgery. ⋯ The perioperative period has the potential to modulate the progression of chronic neurodegenerative diseases. The growing number of elderly having surgery, combined with the expanding life expectancy, indicates the potential for this interaction to have considerable public health implications, and call for further research, especially in humans.
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Curr Opin Anaesthesiol · Aug 2011
ReviewSedation and anesthesia for the pediatric patient undergoing radiation therapy.
Radiation oncology is a cornerstone in the treatment of cancer in children. Although painless, there is a requirement for the child to lie still by themselves in the radiation treatment room, for multiple daily or twice daily treatments for up to 6 weeks. Anesthesia or sedation is usually necessary to achieve this in younger children. This review provides a brief update of the latest developments in radiation oncology and describes the current best practice in anesthesia for these children. ⋯ In the vast majority of cases, total intravenous anesthesia or sedation using propofol ensures that the child remains immobile, whilst maintaining spontaneous respiration, an unobstructed airway, and cardiovascular stability.
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Since the detection of morphine by the pharmacologist Friedrich Sertürner in 1806, opioids have been used as potent centrally acting analgesics. In addition to the central site of action, peripheral endogenous opioid analgesic systems have been extensively studied, especially in the past two decades. This review is not only mentioned to give a brief summary in this well investigated field of peripheral opioid receptors, but also to highlight the role of peripheral opioid receptors in other physiological and pathophysiological conditions. ⋯ Efforts continue to develop opioid analgesics unable to cross the blood-brain barrier, which act only peripherally in low doses, thus providing adequate analgesia without central and systemic side-effects.The awareness of the influence of peripheral opioid receptors beyond nociception may also have therapeutic ramifications on the other fields mentioned above. For example, the treatment of opioid-induced bowel dysfunction by methylnaltrexone is one of the major findings in the previous years.
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To review the recent literature on the implications of occupational radiation exposure in anesthesia practice. ⋯ Radiation is increasingly utilized in medicine for diagnostic and therapeutic procedures. Anesthesia providers may become exposed to unsafe doses while providing high-quality patient care. Understanding of the physical principles, the sources of radiation exposure, the potential risks, and safe practices helps to minimize the exposure risk and its potential deleterious effects to the anesthesia team.