Current opinion in anaesthesiology
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The aim of this review is to give a general overview of anesthetic management, technical considerations and specific complications of interventional neuroradiology based on the most recent literature. ⋯ Interventional neuroradiology is challenging because of the location and the sudden and acutely life-threatening complications that may occur.
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The practice of office-based anesthesia is quickly emerging as an important field for the anesthesia provider. The number of procedures being done in offices around the country has steadily increased, as has the invasiveness of these procedures. This creates new anesthetic considerations. To date most training programs have not addressed this area of practice. As practitioners enter the field, however, they should have information as to how to provide quality care in a location where very often they are completely alone. Many of the safety mechanisms we as anesthesia providers take for granted in a hospital setting are often not present in a surgical office, and it becomes our responsibility to help in establishing standards. ⋯ As office-based anesthesia continues to mature as a specialty, we the anesthesia providers must be proactive in establishing guidelines and recommendations to make the practice safe. We should be informed of the rules and regulations that exist in our states, and we should provide a voice for the patients who put their faith in us.
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In this review we intend to ascertain trends in propofol administration for paediatric anaesthesia and sedation. ⋯ Propofol should be used with extreme caution for prolonged sedation in intensive care unit patients, at dose rates of below 5 mg/kg per h, while maintaining extreme vigilance for signs of developing propofol infusion syndrome. If used correctly propofol is a suitable drug for sedation outside the operating room.
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Ropivacaine is considered less toxic than bupivacaine. In addition, at the low concentrations used for providing postoperative analgesia, ropivacaine seems to produce less motor blockade than bupivacaine. These two properties are of particular interest in paediatric practice. ⋯ Ropivacaine is now the reference drug for regional anaesthesia in paediatric patients, mainly because it is considered less toxic than bupivacaine and provides excellent postoperative analgesia even when used at low concentrations.
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Although postoperative analgesia in infants and children should be an integral part of the perioperative management, undertreatment of pain is not rare in clinical practice and may influence outcome and long term behaviour. Therefore, this review summarizes results of recent papers and discusses actual trends and future perspectives concerning postoperative pharmacologic pain therapy in infants and children. ⋯ The reviewed studies suggest that there are many reliable agents and techniques available to provide a safe and effective postoperative analgesia even in neonates and small infants.