Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewNew antihypertensive medications and clinical implications.
Hypertension remains a global public health issue and is a leading preventable risk factor for many causes of mortality and morbidity. Although it is generally managed as an outpatient chronic disease, anaesthetists will inevitably encounter patients with hypertension, ranging from undiagnosed asymptomatic to chronic forms with end-organ damage(s). ⋯ Although many drugs are familiar, new drug groups that have relevance for blood pressure control and perioperative care have evolved in recent years. This article also describes new antihypertensive agents currently available or under development that could impact perioperative management.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewNewer propofol, ketamine, and etomidate derivatives and delivery systems relevant to anesthesia practice.
Drug discovery is the cornerstone of developments in the field of anesthesia. Each year, new drugs enter the market and possibly change clinical practice. The development of new anesthetics can be divided into two groups. ⋯ Next to drug development, there is also a constant search for better delivery systems for the already available anesthetics. Following open-loop systems like TIVA, new closed-loop systems have entered the market. We also discuss about SEDASYS®-Computer-Assisted Personalized Sedation System, an automatic closed-loop delivery system that provides propofol sedation for endoscopic procedures.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewPerioperative implications of common and newer psychotropic medications used in clinical practice.
Psychotropic medications are widely prescribed by clinicians as both primary therapy for a variety of psychiatric and neurodegenerative diseases and as adjunctive analgesics for use in the perioperative period. It is critical to understand various modes of action, drug-drug interactions, side effects, and clinical implications. ⋯ We will also discuss emerging psychotropic drugs and the challenges they may create during the perioperative period. Future direction of investigation into the role of these drugs during the perioperative period and implications is also discussed.
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Local anesthetics are used for performing various regional anesthesia techniques to provide intraoperative anesthesia and analgesia, as well as for the treatment of acute and chronic pain. Older medications such as lidocaine and bupivacaine as well as newer ones such as mepivacaine and ropivacaine are being used successfully for decades. ⋯ This chapter seeks to summarize the pharmacokinetics of local anesthetics and address the role of newer local anesthetics, as well as clinical implications, safety profiles, and the future of local anesthetic research. Finally, some clinical pearls are highlighted.
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Best Pract Res Clin Anaesthesiol · Jun 2018
ReviewNeuromuscular blockers and reversal agents and their impact on anesthesia practice.
Neuromuscular blockers have long been an intricate part of the anesthesia regimen. The scientific progress in pharmacology and physiology has strengthened their clinical relevance, has helped to delineate with precision their medical role, and has enhanced the safety and effectiveness of their use. New frontiers in research will define further the role of these agents in modern anesthesia practice and guide their expanding and discrete clinical applications.