Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2010
ReviewIs there any relationship between long-term behavior disturbance and early exposure to anesthesia?
There is now more than a decade of mounting animal data that anesthetic drugs can cause apoptosis during a critical period of brain development and that this correlates with later behavioral disturbances. Initial articles examining the effects of early anesthesia on human infants have recently been published. Prospective studies are underway. ⋯ Although the evidence from animal studies is clear and continuing to mount that anesthetic drugs given at the right time and in sufficiently high and prolonged doses do cause increased neuronal apoptosis and later problems with learning, evidence in humans that this is of clinical concern is both weak and mixed. Additional studies are ongoing to try to better define the risk.
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Curr Opin Anaesthesiol · Jun 2010
ReviewAre there still limitations for the use of target-controlled infusion in children?
Target controlled infusion (TCI) devices are gaining popularity among paediatric anaesthesia practitioners because propofol and short-acting opioids allow rapid onset and offset of action, reduce postoperative nausea and vomiting, reduce emergence delirium, lessen exposure to atmospheric pollutants and can be used in peripheral locations. Widespread use remains limited and this review examines reasons why children do not yet enjoy such benefits. ⋯ Hardware limitations, a lack of integrated pharmacokinetic/pharmacodynamic studies and target monitoring issues restrict use. Intravenous induction remains a hurdle, but increasing familiarity with the technique guarantees continued use for maintenance anaesthesia.
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Genomic research in pain, anesthesia and analgesia generated some hope that pharmacogenetics may guide anesthesiologists to provide effective medicine in a 'tailored' manner. Within the field of obstetric anesthesia, relatively few studies have evaluated the effect of polymorphisms on the perception of labor or postcesarean pain or the response to analgesics for childbirth. Because of the multifactorial nature of labor and delivery pain and particularly challenging clinical context, many consider that 'titration of drugs to the desired effect works just fine'. With recent evidence highlighting an association between severe postdelivery pain and persistent pain, early recognition of an increased susceptibility for acute pain has become particularly relevant. ⋯ Although still premature to anticipate clinical implications and a change in practice based on these recent discoveries, genetic variability clearly appears to affect pain perception, response to analgesics and predisposition for the development of chronic pain.
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Labor is among the most painful experiences that humans encounter. Neuraxial analgesia is the most effective means of treating this pain. In this review, we discussed the effect of neuraxial analgesia on the progress of labor when compared with parenteral opioids. We then compared initiation of analgesia with a combined spinal-epidural technique (CSE) to conventional epidural analgesia. Finally we discussed the impact of neuraxial analgesia, given early in labor, compared with later administration. ⋯ Neuraxial analgesia does not interfere with the progress or outcome of labor. There is no need to withhold neuraxial analgesia until the active stage of labor.
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Curr Opin Anaesthesiol · Jun 2010
ReviewWhat are the current indications for noninvasive ventilation in children?
The aims of this paper are to examine the physiological rationale for noninvasive respiratory support (NRS) in children older than 1 month with acute respiratory failure, to review clinical available data and to give some practical recommendations for the safe application of NRS. ⋯ Preliminary clinical data show that NRS is safe and effective in children with acute respiratory failure.