Current opinion in anaesthesiology
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In this article we aim to review the recent literature concerning the management of traumatic brain injury patients, summarize the main findings, and discuss the impact of these findings on clinical practice. ⋯ The key term for the management of traumatic brain injury patients in the early twenty-first century will clearly be 'individualized therapy'. The search of an ideal cerebral perfusion pressure target that would fit every head-injured patients is a utopia. More energy should be focused on the development of reliable tools for outcome prediction and outcome assessment for traumatic brain injured patients. That, and a better targeting of patients entering brain protective trials, should increase the likelihood of demonstrating a significant salvaging effect of a particular treatment in humans.
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Neuropathic pain accounts for 25-50% of pain clinic visits with an estimated prevalence of 4 million. Neuropathic pain is often difficult to diagnose and treat with few pharmacologic options currently available. This review summarizes the latest research on the pathophysiology, diagnosis and treatment of neuropathic pain. ⋯ Neuropathic pain is common, underdiagnosed and undertreated. Diagnosing and understanding the basic mechanisms of neuropathic pain will lead to better treatments of this difficult health care problem.
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This review highlights recent data regarding factors associated with brain arteriovenous malformation hemorrhage and different treatment options. ⋯ The recent identification of clinical and genetic factors associated with brain arteriovenous malformation hemorrhage, as well as studies on treatment outcomes, will help risk stratification in management choices. Future studies are needed to identify arteriovenous malformation patients at the greatest risk of spontaneous hemorrhage and to develop specific medical therapies.
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The purpose of this review is to present the most important recent studies on the clinical use of the combined spinal-epidural technique. ⋯ The use of combined spinal-epidural is widespread and increasing particularly in obstetric anaesthesia and analgesia. Recent literature provides new information about the choice of drugs and technical aspects of the technique and also about its advantages and drawbacks in obstetric and non-obstetric patients.
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This article reviews recent advances in multimodality monitoring of patients following severe head injury during the period of 2004-2005. ⋯ Multimodality neuromonitoring plays an important role in managing patients with severe head injury. It helps guide treatment, provides prognostic information and explores the pathophysiology of evolving brain injury.