Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewPharmacogenomics, precision medicine, and implications for anesthesia care.
The study of how individual genetic differences, known as polymorphisms, change the pharmacokinetics and pharmacodynamics of drugs is called pharmacogenomics. As the field of pharmacogenetics grows and continues to identify genetic polymorphisms, it is promising that the unmet need in this patient population may soon be addressed with personalized drug therapy based on the patient's genetic composition. ⋯ This manuscript describes the current state of precision medicine as it relates to perioperative care and how preoperative genomic analysis can help improve patient outcomes. This investigation also outlines future directions in this important and evolving field.
-
Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewNew anticoagulants, reversal agents, and clinical considerations for perioperative practice.
There are several new anticoagulants on the market that will impact perioperative care, including the use of these anticoagulant drugs in the setting of regional anesthesia. The ideal pharmacological agent would prevent pathological thrombosis and allow for a normal response to vascular injury to limit bleeding. ⋯ These agents can be evaluated by a number of methods including low-, medium-, or high-risk procedures and guidelines and best practice standards that have been published regarding the amount of time to wait after stopping the medication and before performing a procedure, e.g., the American Society of Regional Anesthesia and Pain Medicine recommendations. The present investigation will also describe new reversal agents for anticoagulants and the implications of all these drugs for regional anesthesia.
-
Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewUpdate on nitrous oxide and its use in anesthesia practice.
Nitrous oxide (N2O) is an anesthetic and analgesic gas with a long history of medical applications. It acts on multiple supraspinal and spinal targets and has utility in a wide range of clinical situations. The relative safety, low incidence, and acuity of adverse effects of N2O, along with the ability to be administered by trained medical providers with varying clinical backgrounds, as well as self-administered by patients, assure its persistent and expanding role in clinical practice.
-
Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewAdjunct medications for peripheral and neuraxial anesthesia.
Regional and neuraxial anesthesia can provide a safer perioperative experience, greater satisfaction, reduced opioid consumption, and reduction of pain, while minimizing side effects. Ultrasound technology has aided clinicians in depositing local anesthetic medication in precise proximity to targeted peripheral nerves. ⋯ This manuscript describes the current state of the use of adjuncts, e.g., dexmedetomidine, dexamethasone, clonidine, epinephrine, etc., in regional anesthesia. Additionally, evidence behind dosing and block prolongation is summarized along with patient outcomes, adverse effects, and future directions.
-
Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewPulmonary vasodilators: Latest evidence and outcomes in the perioperative setting.
Numerous conditions give rise to pulmonary arterial hypertension (PAH), with most of them being idiopathic. Signs and symptoms are generally difficult to recognize initially because they present as nonspecific and typically are mistaken for age-related physiological processes or alternate medical conditions. Many advances have been made toward PAH-specific therapies that have led to advanced clinical management of the disease. ⋯ The 6-min walk test is the gold standard in assessing the efficacy of any pulmonary hypertension treatment, and the only drug to show any mortality benefit in pulmonary hypertension is epoprostenol. The present investigation also describes the latest evidence on using these medications in the perioperative period, including clinical trials and practice guidelines. Future direction for research and clinical management of pulmonary hypertension is described.