Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2007
ReviewDuty hours restriction and their effect on resident education and academic departments: the American perspective.
Resident duty hour limits were implemented in 2003 by the Accreditation Council for Graduate Medical Education to improve resident wellness, increase patient safety and improve the educational environment of American residents. Now that academic anesthesiology departments and medical centers have had more than 3 years of experience under the duty hour rules, it is critical to review the available evidence on the effectiveness of these rules. ⋯ Accreditation Council for Graduate Medical Education duty hour rules are generally being followed by American anesthesiology residency programs. Residents perceive an improvement in their overall wellness, but it remains unclear if there has been an improvement in patient safety or quality of resident education.
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There has been an explosion of medical information in the past decade. Current clinical practice demands that anesthesiologists be aware of current treatments and procedures, along with the latest practice standards and guidelines. The need to be able to rapidly retrieve relevant, accurate clinical information at the point of care is now felt more than ever. This review explores the impact of clinical medical librarians, with particular emphasis on their application in the perioperative setting. ⋯ Anesthesiologists have particular information needs for which the physical library is no longer sufficient. New outcome measures to define the 'success' of clinical medical librarian programs need to be formulated, and economic considerations need to be factored into these programs.
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Curr Opin Anaesthesiol · Oct 2007
ReviewGabapentin and pregabalin for chronic neuropathic and early postsurgical pain: current evidence and future directions.
Gabapentin and pregabalin bind to the alpha-2-delta calcium channel subunit and represent a novel analgesic drug class. The evidence base supporting their use for chronic neuropathic and early postsurgical pain is reviewed. ⋯ Gabapentin and pregabalin are efficacious treatments for neuropathic and postsurgical pain. Future research addressing several specific questions would serve to better delineate their optimal roles in treating these and other pain conditions.
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Genomic variations influencing basal pain sensitivity, the likelihood of developing chronic pain diseases as well as the response to pharmacotherapy of pain are currently under investigation Here, we review examples of promising approaches to diagnose genetic predisposition from recently published studies. ⋯ The article reviews recent studies on genetic variables influencing pain and pharmacotherapy. Examples of promising candidate genes have been intensively studied during recent years. Although the number of subjects investigated is often small, published data and current advances in genotyping and study design suggest valid and clinically relevant results to date and even more in the future.
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Curr Opin Anaesthesiol · Oct 2007
ReviewGeneral anesthetic-induced neurotoxicity: an emerging problem for the young and old?
A growing body of evidence from cells, rodents, and sub-human primates suggests that general anesthetics can be neurotoxic to the developing and senescent brain. We review this evidence and put the studies into perspective for the practicing clinician. ⋯ General anesthetics produce neurotoxicity and enduring cognitive impairment in young and aged animals but it is premature to change clinical practice because the issue has not been adequately studied in humans.