Articles: anesthetics.
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J. Cardiothorac. Vasc. Anesth. · Nov 2023
EditorialMechanisms of Action of the Detrimental Effects of Propofol on Survival.
Due to its favorable pharmacologic features, propofol is the most commonly used hypnotic agent in perioperative and intensive care settings. However, it also has adverse effects like propofol infusion syndrome and an increased risk of infection. Growing evidence suggests that propofol may worsen clinical outcomes by inhibiting the organ-protective properties of other interventions, such as volatile anesthetics or remote ischemic preconditioning. This editorial describes possible mechanisms underlying the detrimental effects of propofol, and provides an overview of the results of clinical trials evaluating the effects of propofol in various settings.
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Editorial Comment
The art of chasing numbers in titration of anaesthetic dose.
There is no difference in between-patient variability of concentrations when comparing propofol and sevoflurane titrated to a bispectral index of 40-60. There is about a 300% variation in hypnotic concentration between the bottom 5% and top 5% of the population. Anaesthesia titration cannot be based solely on measured or estimated drug concentrations.
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Editorial Comment Review
Consensus guidelines, Delphi methods, and evidence around anaesthetic technique for endoscopic retrograde cholangiopancreatography.
Consensus guidelines on the anaesthetic management of endoscopic retrograde cholangiopancreatography (ERCP) have recently been published. The rigorous synthesis of expert opinion is invaluable when there are limited data, and these guidelines are a significant step forward. This review both guides practice and identifies important research questions. We challenge those working in this field to collaborate and produce the evidence for whether monitored anaesthesia care (MAC) is associated with a lower incidence of adverse events and better outcomes than general anaesthesia for ERCP.
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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.