Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2007
ReviewBlood substitutes as pharmacotherapies in clinical practice.
To discuss the development and current status of blood substitutes, including hemoglobin-based oxygen carriers (HBOCs) and perfluorocarbons. Research in this field offers an important view into the future of transfusion medicine in the operating room, as well as in trauma and combat arenas. ⋯ Polymerized hemoglobin preparations have proven most successful in clinical trials due to their improved side-effect profile. The goal is to evaluate blood substitutes with enhanced intravascular retention, reduced osmotic activity, and attenuated hemodynamic derangements such as vasoconstriction. Although not without substantial morbidity and mortality, the current safety of allogeneic blood transfusion demands that comparative studies show minimal adverse effects, as well as efficacy and potential for novel applications.
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Curr Opin Anaesthesiol · Aug 2007
ReviewThe nature of anesthesia and procedural sedation outside of the operating room.
Procedural sedation and monitored anesthesia care have become increasingly common in locations outside of the operating room. The different types of procedures are presented along with pertinent safety issues with the use of different drug combinations. ⋯ The number and types of procedures done outside of the operating room are steadily increasing. Sedation for these is often provided by nonanesthesiologists. A quality assurance system dedicated to track events associated with procedural sedation and anesthesia done outside of the operating room is instrumental for the maintenance of exemplary quality of sedation and safety of our patients.
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The cardiac catheterization lab has concerns for both patient care and for safety. As the cardiac catheterization lab continues to evolve, the demand for anesthesia services will certainly increase. The role of the anesthesiologist in the cardiac catheterization lab must be defined in this changing environment. ⋯ The anesthesiologist is becoming an integral part of the cardiac catheterization lab team, and an important element in maintaining a high level of patient care with minimal complications in the evolving modern day cardiac catheterization lab.
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Curr Opin Anaesthesiol · Aug 2007
ReviewSedation for gastrointestinal endoscopy: the changing landscape.
Most patients require sedation for gastrointestinal endoscopy. Moderate sedation for these procedures has traditionally been provided by the endoscopist with benzodiazepine and/or a narcotic. As endoscopy has increased in numbers and complexity, however, more effective sedation and analgesia is frequently required. Controversy has ensued over safe and efficient sedation practice. This review seeks to delineate what has been learned about this topic in the recent literature. ⋯ Alternatives to anesthesiologist-supervised propofol include nurse-administered propofol sedation supervised by the endoscopist, and patient controlled sedation. While other sedative regimens continue to be examined, the use of propofol for gastrointestinal endoscopy will continue to increase. Structured nurse-administered propofol programs appear to be safe, but the occurrence of severe respiratory depression and the ability to rescue remain concerns. Further study into appropriate sedation training, patient selection, ability to rescue, complications and value of anesthesiologist-directed sedation is necessary.
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Curr Opin Anaesthesiol · Aug 2007
ReviewAnesthesia practice in the emergency department: overview, with a focus on airway management.
To review the need for interdisciplinary collaboration to reduce human and system-related errors in the emergency care setting. ⋯ The implications of collaboration are sweeping; not only for optimizing patient care but leading to a 'win-win' situation for medical personnel by improving relationships to better address global needs and optimize the opportunities for collaboration, which is particularly true for urgent/emergent airway management.