Anesthesiology clinics
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Anesthesiology clinics · Dec 2010
ReviewDexmedetomidine: clinical application as an adjunct for intravenous regional anesthesia.
The selective α-2 adrenoceptor agonist, dexmedetomidine, has been shown to be a useful, safe adjunct in perioperative medicine. Intravenous regional anesthesia is one of the simplest forms of regional anesthesia and has a high degree of success. However, intravenous regional anesthesia is limited by the development of tourniquet pain and its inability to provide postoperative analgesia. ⋯ The antinociceptive effects of α-2 adrenoceptor agonists have been shown in animals and in humans. However, less is known about the clinical effects of dexmedetomidine when coadministered with local anesthetics in patients undergoing intravenous regional anesthesia. This review examines what is currently known to improve our understanding of the properties and application of dexmedetomidine when used as an adjunct in intravenous regional anesthesia.
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Over the last several decades, the average age of patients has steadily increased, whereas the use of general anesthesia and deep sedation has grown largely outside the operating room environment. Currently available general anesthetics and delivery models represent limitations in addressing these trends. At the same time, research has tremendously expanded the knowledge of how general anesthetics produce their beneficial effects and also revealed evidence of previously unappreciated general anesthetic toxicities. The goal of this review is to highlight these important developments and describe translational research on new general anesthetics with the potential to improve and reshape clinical care.
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Several decades ago, the analgesic properties of buprenorphine were discovered. Its approval for the use as an agent for the treatment of opioid abuse has led to increasing numbers of patients presenting for surgery on buprenorphine. This article describes the challenges, advantages, and disadvantages of the use of buprenorphine as an analgesic for postoperative pain in patients with and without preoperative maintenance therapy.
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Anesthesiology clinics · Sep 2010
ReviewApplications of ultrasonography in ENT: airway assessment and nerve blockade.
This article presents a comprehensive narrative review of the published literature relating to ultrasound imaging relevant to anesthesia for ear, nose, and throat (ENT) surgery. The review comprises 2 main subject areas: the use of ultrasonography related to assessment and management of the airway, and the use of ultrasonography related to nerve blockade for ENT surgery. The relevant sonoanatomy and suitable probe placement are illustrated in relation to applicable regional anatomy (they are not discussed). The possible value of the use of ultrasonography to improve existing clinical practice in these areas is explored.
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Anesthesiology clinics · Sep 2010
ReviewLaser surgery and fire hazards in ear, nose, and throat surgeries.
Operating room fires are rare but can be devastating. These fires can occur during almost any surgical procedure but are more likely during airway surgery, during head and neck surgery, and if volatile flammable liquids are used. Each team in the operating room (ie, anesthesia, surgery, and nursing) has special expertise and responsibility in preventing and responding to a fire. Fires can be prevented by ongoing education and an interdisciplinary discussion of risks and responsibilities prior to each high-risk case.