Current opinion in anaesthesiology
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It is timely to review recent publications that add to our knowledge of malignant hyperthermia because we can go to the web or to newspapers and read of recent tragic malignant hyperthermia deaths. ⋯ Because malignant hyperthermia is potentially lethal, families should be evaluated as thoroughly as possible when an individual who claims to be malignant hyperthermia susceptible presents for elective surgery. Genetic testing may facilitate the evaluation of families with a very strong history of malignant hyperthermia. The use of activated charcoal can speed the removal of potent inhalation anesthetics from anesthesia workstations. This should facilitate the anesthetic care of malignant hyperthermia susceptible patients.
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Curr Opin Anaesthesiol · Dec 2009
ReviewPerioperative management of outpatients with implantable cardioverter defibrillators.
Implantable cardioverter defibrillators (ICDs) are increasingly being placed in patients worldwide. These patients pose significant perioperative challenges and are at an increased risk of complications; the suitability of ambulatory surgery in this patient population remains controversial. The purpose of the present review is to examine the potential challenges and optimal perioperative care of patients with an ICD. ⋯ Anesthesia practitioners involved in the care of patients with ICDs should familiarize themselves with the response to magnets application on ICD function as well as understand the situations in which magnet use is not advisable. Perioperative communication with the patient's cardiologist and surgeon is critical in reducing adverse outcome.
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The present review article provides a summary of the recent literature evaluating the technology for monitoring depth of anesthesia and patient outcomes associated with its use. ⋯ The goal of precisely dosed general anesthesia guided by brain monitoring remains elusive.
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The focus of intraoperative monitoring is moving away from invasive monitoring. This has been attributed to procedure time, cost, and the known risks, which include carotid artery puncture, arrhythmia, pneumothorax, and infection. Until recently, the venous system's contribution to the circulatory system has been incorrectly identified as being insignificant. This article summarizes the unique characteristics of the peripheral venous system. ⋯ The veins play a critical role in cardiovascular homeostasis; they do more than conduct blood to the heart. Considering the ease of measurement from a peripheral intravenous catheter, further study should be conducted to investigate the usefulness and limitations of such a minimally invasive and inexpensive monitoring device.
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Curr Opin Anaesthesiol · Dec 2009
ReviewTotal intravenous anaesthesia techniques for ambulatory surgery.
The purpose of the present review is to provide an updated discussion on the use of total intravenous anaesthesia (TIVA) for ambulatory surgery, based on results from recent studies put into the context of issues already known. ⋯ TIVA is well tolerated and simple. It is associated with less postoperative nausea and vomiting than inhalational anaesthesia and has no residual paralyses as are possible with locoregional techniques. Propofol with remifentanil seems to be the dominating TIVA technique, delivered either by conventional pumps or by target control systems.