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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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.
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This review will highlight the recent functional magnetic resonance imaging, positron emission tomogram scan and connectivity studies in anesthesia and analgesia. ⋯ Slowly, a pattern of neuronal activity reflecting hypnosis, analgesia, amnesia and reflex suppression seems to be emerging giving us a better insight into the central nervous system effects of anesthesia.
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The use of ultrasound for peripheral nerve blockade is becoming popular. Although the feasibility of ultrasound-guided nerve blockade is now clear, it is uncertain at this time whether it represents the new standard for regional anesthesia in terms of efficacy and safety. ⋯ Ultrasound is a valuable tool that is now available to the regional anesthesiologist, and it is fast becoming a standard part of practice. It promises to be of especial value to the less experienced practitioner. Ultrasound does not in itself, however, guarantee the efficacy and safety of peripheral nerve blockade. Proper training in its use is required and we can expect to see the development of formal standards and guidelines in this regard.
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Curr Opin Anaesthesiol · Oct 2008
ReviewAnesthesia for functional neurosurgery: the role of dexmedetomidine.
The purpose of this review is to summarize current approaches to the anesthetic management of functional neurosurgery and to describe the application of an alpha-2-adrenergic agonist dexmedetomidine in the anesthetic management of functional neurosurgical procedures. ⋯ Dexmedetomidine has been demonstrated to provide a successful sedation without impairment of electrophysiologic monitoring in functional neurosurgery. Prospective randomized studies are warranted to delineate an optimal regimen of dexmedetomidine sedation and any dose-related influence on neurophysiologic function.