Current opinion in anaesthesiology
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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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This review was performed through a Medline research to evaluate articles published between January 2004 and April 2005. Technical procedures, indications, drugs, infusion regimens, and complications of continuous peripheral nerve blocks were considered. ⋯ Continuous peripheral nerve blockade is an effective and safe technique for postoperative analgesia, even when administered at home. To optimize this technique, further studies are needed to help minimize the risk of side effects, improve techniques to locate the targeted nerve (stimulating catheters or ultrasound imaging) and choose less toxic drugs (levobupivacaine and ropivacaine) with more effective infusion regimens.
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In past years, important advances have been made in the treatment of idiopathic headache disorders. New controlled trials have been published for the acute and the prophylactic drug and non-drug therapies. Furthermore, new headache entities have been described by the International Headache Society for which treatment recommendations can be given. ⋯ Recent advances in headache treatment comprise growing evidence for an appropriate drug administration and for differential drug therapy rather than the development of new drugs or procedures. Surgical and other non-drug treatment procedures are under discussion and might be an additional tool for headache treatment in future years.
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Curr Opin Anaesthesiol · Oct 2005
Postoperative pain, nausea and vomiting in neurosurgical patients.
Postoperative pain and postoperative nausea and vomiting are significant problems for neurosurgical patients and their carers. The treatment of these problems is widely perceived to be inadequate, however, especially in patients undergoing craniotomy, and there are few large, randomized controlled trials. The main issue has been fear of side effects, especially those masking neurological signs. A review of the recent literature therefore is justified. ⋯ There is still a lot of scope to research and refine pain and postoperative nausea and vomiting management in cranial and spinal neurosurgical patients. Large-scale studies are required to define the current state of practice, determine effective treatments and define the incidence of side-effects.
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Analysis of recent data indicates a clear benefit of carotid endarterectomy for symptomatic patients with high-grade carotid artery stenosis, and a marginal benefit for asymptomatic patients. Despite myriad challenges presented by patients undergoing carotid endarterectomy, excellent outcomes have been achieved and many centers have shown the technique to be safe as an outpatient procedure for specific populations. Greater attention to comorbidities and their management in the perioperative period is increasingly important as older and more complex patients present for invasive treatment of carotid disease. Scientific study aimed at defining which characteristics merit our attention will only lead to improved outcomes and greater understanding of carotid disease, endarterectomy and anesthesia. While controversial, the efficacy, safety, and durability of stenting and angioplasty have improved in recent years. Potential advantages of stenting and angioplasty of the carotid artery include avoiding cranial nerve damage, wound hematoma, and general anesthesia. Staying abreast of the science regarding such endovascular therapies will be increasingly important. ⋯ Patients with significant comorbidities may be managed safely by a variety of anesthetic techniques. Maintaining hemodynamic stability and monitoring cerebral oxygen delivery remain important goals of perioperative management. Recent data regarding the durability and safety of stenting and angioplasty of the carotid artery suggest that outcomes may approach those of carotid endarterectomy.