Best practice & research. Clinical anaesthesiology
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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.
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Even nowadays every third or fourth patient suffers from postoperative nausea and vomiting (PONV) after general anaesthesia with volatile anaesthetics. There is now strong evidence that volatile anaesthetics are emetogenic and that there are no meaningful differences between halothane, enflurane, isoflurane, sevoflurane, and desflurane in this respect. However, when propofol is substituted for volatile anaesthetics the risk for PONV is reduced by only about one fifth, indicating that there are other even more important causes for PONV following general anaesthesia. ⋯ This means that any anti-emetic prophylaxis for PONV induced by volatile anaesthetics is equally effective. Of course, the most logical approach for prevention would be the omission of volatile anaesthetics and nitrous oxide using a total intravenous anaesthesia with propofol. However, since volatile anaesthetics are probably not the most important risk factors, it might be even better--if appropriate--to avoid general anaesthesia by using a regional, opioid-free anaesthesia if PONV is a serious problem.