Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewDifferences between and combinations of opioids re-visited.
Recent studies highlighting between-opioid differences in patient outcomes, opioid receptor interactions and animal study findings implicating a 'fine control' mechanism underpinning potential diversity in opioid receptor signalling that could potentially be exploited to develop novel opioid analgesics with improved tolerability are reviewed. ⋯ Enhanced understanding of diversity in opioid signalling has the potential to produce novel strong opioid analgesics with improved tolerability.
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Clinical and experimental data suggest that hypergylcaemia lowers the ischaemic neuronal threshold and worsens outcome in the presence of neurological injury from trauma, stroke and subarachnoid haemorrhage. This review aims to appraise the evidence for tight glycaemic control in patients with neurological injury. ⋯ Clinical and experimental data suggest that hyperglycaemia lowers the ischaemic neuronal threshold in the presence of neurological injury. Tight glycaemic control may result in hypoglycaemia, which in itself can be detrimental. Therefore, it seems sensible that we should accept slightly less tight blood glucose control than in the critically ill patient without neurological injury.
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Central neuropathic pain is an important and disabling but often neglected problem following central nervous system lesions. The present review highlights recent advances in the understanding of the underlying mechanisms and in the diagnosis and treatment of central pain. ⋯ Increased insight into the mechanisms of central pain will hopefully lead to increased efforts to study mechanism-based treatment of central pain.
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Curr Opin Anaesthesiol · Oct 2008
Review Comparative StudySaline versus balanced hydroxyethyl starch: does it matter?
A total balanced volume replacement strategy is a new concept for correcting hypovolemia. To fulfill this concept, balanced colloids, for example, balanced hydroxyethyl starch (HES) solutions, are necessary in addition to balanced crystalloids. Conventional HES solutions consist of saline with abnormally high concentrations of sodium (154 mmol/l) and chloride (154 mmol/l). ⋯ Although only a few studies using balanced HES solutions are available at present, it is difficult to argue against using HES preparations that are adapted to plasma instead of HES preparations that contain unphysiologic saline solution. First results are very promising - large clinical trials are necessary to assess the value of a total balanced volume replacement strategy including plasma-adapted HES solutions.