Current opinion in anaesthesiology
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The debate continues as to whether regional anesthesia is safer than general anesthesia. However, the choice of anesthetic technique is a complex decision. This review of the most recent publications compares the safety of regional anesthesia with that of general anesthesia.
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Combining regional and general anaesthesia can have many advantages, particularly in patients undergoing major thoracic, abdominal or orthopaedic surgery. The use of regional anaesthetic techniques in anaesthetized children is an accepted standard of care, because needle and procedure phobias are very common and can result in severe anxiety, an inability to cooperate and sudden unpredictable movement. Epidural local anaesthetics have the potential of attenuating sympathetic hyperactivity, maintaining bowel peristalsis, sparing the use of opioids, and facilitating postoperative feeding and out-of-bed activity. ⋯ The present review focuses on the use of a combination of regional and general anaesthesia for a variety of surgical procedures. It also compares the two anaesthetic techniques in elderly patients. The review is based on studies published during the past year.
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Recently there has been a considerable increase in interest in regional anesthesia and neural blockade. Many traditional nerve block techniques have been significantly modified to better fit the realm of both inpatient and outpatient surgery. ⋯ A significant effort has also been invested in studying and improving the safety of various techniques. These developments, coupled with an increased emphasis on teaching of regional blocks by organized anesthesia societies are likely to result in a wider use of these techniques in years to come.
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In past years, cerebral monitoring was mostly focused around global cerebral perfusion and metabolism monitoring, with the use of transcranial Doppler recordings, jugular bulb oximetry and near-infrared spectroscopy. Most of the recently introduced cerebral monitoring modalities, such as brain tissue partial oxygen tension monitoring and cerebral microdialysis, offer new opportunities by providing regional information on the specific brain area in which the probe is inserted. ⋯ In this case, the combination of global and regional cerebral monitoring might offer the best information on which to base patient management. Also, the introduction of more clinically useful, functional neuroimaging techniques may be a valuable adjunct to future neurological critical care management.