Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2009
ReviewMultimodal analgesia for controlling acute postoperative pain.
Multimodal analgesia is needed for acute postoperative pain management due to adverse effects of opioid analgesics, which can impede recovery; a problem that is of increasing concern with the rapid increase in the number of ambulatory surgeries. Yet, the literature on multimodal analgesia often shows variable degrees of success, even with studies utilizing the same adjuvant medication. ⋯ There is a continuing need to explore new drug combinations to achieve all of the purported goals of multimodal anesthesia.
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Curr Opin Anaesthesiol · Oct 2009
ReviewThe role of acupuncture and transcutaneous-electrical nerve stimulation for postoperative pain control.
Both patients and care providers are concerned about the adverse events associated with pharmaceutical approaches used in postoperative pain management. Acupuncture and transcutaneous-electrical nerve stimulation (TENS) are complementary treatment techniques and are very popular in the management of a variety of painful conditions. Therefore, their use might help to reduce opioid requirements and decrease the incidence of medication-related adverse events. The aim of this review is to summarize the latest findings on the use of acupuncture and TENS in postoperative pain management. ⋯ Evidence of efficacy in recent studies on acupuncture and TENS in management of postoperative pain is limited. However, some high-quality studies clearly show positive results for both methodologies. As these techniques cause no harm, their use as adjunct to conventional pharmaceutical approaches could be considered particularly for patients in whom conventional techniques fail and/or are accompanied by severe medication-related adverse events.
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Pediatric traumatic brain injury (TBI) is associated with significant morbidity and mortality. The purpose of this review is to discuss emerging concepts and to provide an update on the clinical evaluation, management, and predictors of outcome after pediatric TBI. ⋯ As TBI is the leading cause of death in children, research in this area is needed to advance our knowledge of the sequelae after and improve outcomes of children with TBI.
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The use of pharmacological thromboprophylaxis in the perioperative period may conflict with regional anesthetic techniques in which maintaining hemostatic integrity is essential. Recently, new anticoagulants have been developed with more efficacy and a better safety profile. This article reviews the basis for the actual recommendations and the current status and management of these new drugs. ⋯ When new anticoagulant drugs are used for thromboprophylaxis in orthopedic surgery, the performance of neuraxial anesthetic techniques should be based on their pharmacology. If a peripheral blockade is chosen, these recommendations should be followed when a block is performed in a noncompressible area.
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Sedation is a well recognized technique to improve patients' acceptance and comfort during regional anesthesia. The use of this technique is growing exponentially and is nowadays applied not only in the operating room but also in many other different locations within and outside the hospital. ⋯ The explosion of sedation well beyond the world of regional anesthesia has raised new challenges. Some sedative procedures will be performed more and more often by nonanesthesiologists in the future. This trend is inevitable due to limited resources and stresses on the importance of building up education and teaching programs for nonanesthesiologists. The need for reliable devices for monitoring of sedation and new hypnotics, which have even better phamacokinetics than those available, are needed to match the new issues of sedation.