Best practice & research. Clinical anaesthesiology
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The volatile anaesthetics sevoflurane and desflurane feature new and promising properties. Their low blood and tissue solubility enables rapid onset of and emergence from anaesthesia, thus enhancing patient safety and comfort. ⋯ The first part focuses on pharmacokinetic issues such as substance properties, uptake and elimination. The second part covers the effects of inhaled anaesthetics on organ systems, with emphasis on the central nervous system, the cardiovascular system, the respiratory tract, liver and kidneys.
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Best Pract Res Clin Anaesthesiol · Sep 2005
ReviewInert gases as the future inhalational anaesthetics?
Of all the inert gases, only xenon has considerable anaesthetic properties under normobaric conditions. Its very low blood/gas partition coefficient makes induction of and emergence from anaesthesia more rapid compared with other inhalational anaesthetics. ⋯ Xenon causes several physiological changes, which mediate protection of the brain or myocardium. The use of xenon might therefore be beneficial in certain clinical situations, as in patients at high risk for neurological or cardiac damage.
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Anaesthetic agents display remarkable neuroprotective potential; here, we describe the evidence supporting its use and highlight areas for future development of the field. In particular the application of isoflurane and/or xenon as inhalational neuroprotectants is advocated and evidence for the neuroprotection provided by barbiturates and suppression of cerebral metabolic rate is discussed.
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Best Pract Res Clin Anaesthesiol · Sep 2005
ReviewInhalational anaesthetics in the ICU: theory and practice of inhalational sedation in the ICU, economics, risk-benefit.
ICU sedation poses many problems. The action and side-effects of intravenous drugs in the severely ill patient population of an ICU are difficult to control. The incidence of post-traumatic stress disorder after long-term sedation is high. ⋯ This 'anaesthetic conserving device' (AnaConDa) is connected between the patient and a normal ICU ventilator, and it retains 90% of the volatile anaesthetic inside the patient just like a heat and moisture exchanger. In this chapter possible advantages of the new concept and the choice of the inhalational agent are discussed. The technical prerequisites are explained, and the practice and pitfalls of inhalational ICU sedation in general and when using the AnaConDa are described in detail.
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Inhalation agents are amongst the mainstays of paediatric anaesthesia, as children are often induced by mask before venous access is obtained. Children do not like needles and obtaining venous access in an awake and moving child can be very demanding. Safety aspects are of particular importance in paediatric anaesthesia. ⋯ Inhalation anaesthesia has a long tradition, whereas the experience with propofol is comparatively small. The incidence and clinical relevance of the propofol infusion syndrome during clinical anaesthesia are still unknown. Inhalation anaesthesia is still considered to be the gold standard by the overwhelming majority of paediatric anaesthetists world-wide, however, intravenous techniques can be an attractive alternative in specific clinical situations.