Current opinion in anaesthesiology
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Dentistry treatment is one of the most anxiety-inducing events in people's lives. The development of pain and anxiety-control techniques has always been very closely aligned to the development of dentistry. The purpose of this review is to summarize the recent literature in this field. ⋯ Considerable progress is being made with a number of innovative techniques. Oral midazolam for children and patient-controlled propofol show very promising results. More research is needed before propofol can be recommended for use without anaesthetic staff. The recently published systematic review of sedation in children outlines gaps in the literature and contains recommendations for future work.
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The recent year's literature is reviewed concerning the use of sedation in the emergency department. The use of moderate to deep sedation is becoming common in emergency medicine for many reasons, including progressive hospital crowding, limited availability of anesthesia, and increased training in residency. This is performed for a wide variety of procedures, most commonly orthopedic. ⋯ The year's literature reflects the reality that the performance of sedation in the emergency department is advantageous. As the era of evidence-based medicine continues to provide us with more and better information, the combined efforts of both anesthesiology and emergency medicine can hopefully contribute to improving patient safety with respect to procedural sedation.
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Anesthesia care for patients undergoing ambulatory gynecologic surgery has improved incrementally over the past few years. Emphasis has evolved beyond the safe provision of care, because this has largely been achieved. Comfort, speed, and efficiency have taken on new importance. ⋯ Local anesthetic use in gynecologic laparoscopy appears to improve postoperative pain control modestly, especially when given into the peritoneal cavity. Supralaryngeal airways, such as ProSeal LMA, appear to provide effective ventilation in laparoscopy, although their ability to protect against aspiration is unclear. The speed and comfort of emergence, recovery, and discharge may be improved by consciousness monitoring during general anesthesia and by drugs intended to modulate hemodynamics.
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Cancer is beginning to outpace cardiovascular disease as the primary cause of death in the developed world. A majority of cancer patients will require anaesthesia either for primary debulking tumour removal or to treat an adverse consequence of the malignant process or its treatment. Therefore we outline here the pathophysiology of cancer, generalized metastatic disease and systemic chemotherapy and radiotherapy on major organ systems. The anaesthetic considerations for optimum perioperative management of cancer patients are discussed, and the possibility of anaesthetic technique at primary cancer surgery affecting long-term cancer outcome is mentioned. ⋯ Optimum perioperative patient care requires individual assessment of the impact of cancer and its treatment on the functional reserve of all major organ systems. The potential of anaesthetic technique at cancer surgery to influence long-term cancer outcome merits investigation.