Articles: anesthetics.
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Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively. ⋯ There is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery.
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Editorial Comment
Phase-amplitude coupling during maintenance of general anaesthesia: towards a better understanding of anaesthetic-induced brain dynamics in children.
Electroencephalogram signatures associated with anaesthetic-induced loss of consciousness have been widely described in adult populations. A recent study helps verify our understanding of brain dynamics induced by anaesthetics in a paediatric population by describing a specific pattern in terms of an interaction of the phase of delta oscillations and the amplitude of alpha oscillations. This feature has potential translational implications for optimising future monitoring technologies.
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Anesthesia and analgesia · Sep 2023
Components of General Anesthesia: History of the Concept Transformation.
The concept that the state of general anesthesia consists of a number of components representing the distinct and desired central effects of general anesthetics was formulated when it was common to believe that all components of anesthesia have a lipid-centered mechanism of action. The transformation of this concept was associated with changes in our understanding of the mechanisms underlying general anesthetic action. First came the shift from a lipid- to a protein-centered mechanism of action, which opened the way to various molecular targets associated with general anesthesia. ⋯ There are several important consequences of our improved understanding. First, a single measurement of anesthetic depth (eg, minimum alveolar concentration index [MAC index]) might not be appropriate for the different component of anesthesia. Second, because the mechanism of action of the components varies, synergy for 1 component does not exclude an additive effect or even antagonism for another component.
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Anesthesia and analgesia · Sep 2023
Pro-Con Debate: Should All General Anesthesia Be Done Using Target-Controlled Propofol Infusion Guided by Objective Monitoring of Depth of Anesthesia?
In this Pro-Con commentary article, we discuss whether all general anesthesia should be done using target-controlled propofol anesthesia guided by monitoring of depth of anesthesia. This is an ongoing debate since more than 25 years, representing a scientific, cultural as well as geographical divide in the anesthesia community. The Pro side argues that total intravenous anesthesia causes less postoperative nausea and higher patient satisfaction than anesthesia using volatile anesthetics. ⋯ A well-balanced choice based on the available literature is recommended. The authors recommend careful consideration of advantages and disadvantages of each technique when tailoring an anesthetic to meet patient needs. Where appropriate, anesthesia providers are encouraged to account for unique features of anesthetic drug behavior, patient-reported and observed postoperative outcomes, and economic and environmental considerations when choosing any of the 2 described techniques.