Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2009
ReviewPharmacokinetic-pharmacodynamic modeling in anesthesia, intensive care and pain medicine.
Studies from the anesthesiology literature published in the last 2 years were selected to illustrate the most important developments in the field of pharmacokinetic-pharmacodynamic modeling. ⋯ Progress was made by improving population pharmacokinetic/pharmacodynamic models, developing new indexes to measure drug effect and using them in an adaptive delivery system to the individual patient.
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Safety, quality, and patient satisfaction are not only defined by the incidences of serious adverse events but also include postoperative outcomes such as postdischarge nausea and vomiting (PDNV). PDNV has a high impact on patient recovery and may influence the cost-effectiveness of office-based surgical procedures. This article reviews the incidences and risk factors for PDNV as well as medications and concepts for prophylaxis and treatment. ⋯ PDNV is an under-recognized problem after outpatient anesthesia. Valid data for the incidence and the best treatment of PDNV after office-based anesthesia are rare. For safety, quality, and patient satisfaction, further research is needed to develop a prediction model to better identify patients at risk for PDNV in order to direct antiemetic prophylaxis for ambulatory patients undergoing office-based anesthesia.
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Toxicity concerns and awareness during anesthesia issues continue to concern pediatric anesthesiologists. Most developmental pharmacokinetic, pharmacodynamic and pharmacogenomic changes occur within the first year of life. Understanding these early changes can improve drug use in this cohort. ⋯ Mechanistic models create a framework for the study of pharmacokinetic changes in infancy. Understanding these changes allows a target concentration approach to therapy and potential for reduced toxicity. The target concentration may be undefined because of a paucity of effect measures.
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Curr Opin Anaesthesiol · Jun 2009
ReviewCan we predict persistent postoperative pain by testing preoperative experimental pain?
Although it is recognized that medical and surgical procedures may lead to persistent postoperative pain, predicting which patients are at risk for developing chronic pain presents an ongoing challenge. Clinical observations indicate that similar invasive procedures associated with consequent peripheral tissue damage can cause a wide range of pain experience. This broad variability is likely a consequence of the diversity in the central pain processing of the peripherally generated noxious stimulation. Therefore, advanced psychophysical measures that dynamically represent central pain modulation mechanisms may be used to determine an individual's susceptibility to developing persistent postoperative pain. This review highlights how, and to what extent, preoperative experimental pain testing can be utilized in predicting persistent postoperative pain. ⋯ The preoperative identification of individuals who have enhanced pain sensitivity and are at risk for developing persistent postoperative pain is important to providing them with better treatment that is specifically tailored to their altered pain modulation, as represented psychophysically.
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Curr Opin Anaesthesiol · Jun 2009
ReviewAnaesthetic issues in women undergoing gynaecological cytoreductive surgery.
Increasing numbers of women with ovarian cancer are undergoing cytoreductive surgery in reference centres. This review looks at this disease in these women and the different aspects of perioperative clinical management of these patients by the anaesthetic team: preoperative screening, anaesthetic techniques, fluid or blood management or both and prevention and treatment of important complications. ⋯ Anaesthesia is more than 'keeping asleep'. Anaesthesiologists have an enormous responsibility in the preoperative, peroperative, and postoperative period for patients undergoing gynaecological cytoreductive surgery.