Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2010
ReviewThe clinical (ir)relevance of opioid-induced immune suppression.
Opioid-induced immune suppression has been demonstrated in cell culture experiments and in animal models. This review examines whether opioids also increase the risk of infections in the perioperative setting or on the ICU. ⋯ In contrast to in-vitro studies and to animal models, conclusive evidence is currently lacking that opioids induce clinically relevant infectious complications in patients. However, these findings should be interpreted with great caution, as almost no adequately designed trials have been performed. Peripherally selective opioid receptor antagonists might be useful if opioid-induced immune suppression should prove to be clinically relevant.
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Curr Opin Anaesthesiol · Oct 2010
ReviewConditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states.
There is a growing body of knowledge on pain modulation in various disease states. This article reviews the state of the art regarding the clinical relevance of pain inhibition as revealed by 'pain inhibits pain' test paradigms, trying to organize the clinically relevant data, and emphasizing the pathophysiology of pain. In line with recent experts' recommendations, the term conditioned pain modulation (CPM) will be used, replacing the previous terms 'diffuse noxious inhibitory control (DNIC)' or 'DNIC-like' effects. ⋯ Low CPM efficiency is associated with higher pain morbidity and vice versa. Further work is awaited on clarifying plasticity of CPM and its relevance to selection and efficacy of pain therapy.
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Postoperative vision loss (POVL) as related to spinal surgery and the prone position has garnered increasing attention in the US over the last 15 years, resulting in an increase of litigations submitted to the legal system. It might be associated with the development of new surgical techniques involving complex instrumentation of the spine. By 2000, the magnitude of this problem was such that the American Society of Anesthesiologists developed a Postoperative Visual Loss Registry in an effort to better understand and evaluate this devastating operative complication. ⋯ ION is still poorly understood and risk factors remain speculative. Given that there is no known treatment, increased understanding should help to prevent this postoperative complication.
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Curr Opin Anaesthesiol · Oct 2010
ReviewContinuous central and perineural infusions for postoperative pain control in children.
Continuous infusion remains the technique of choice when there is a prolonged operation or intense postoperative pain is anticipated. Supplementing a general anesthesia with a nerve block can result in a pain-free awakening and postoperative analgesia without the potentially deleterious effects associated with parenteral opioids. The literature confirms the very low rate of complications and adverse effects of regional anesthesia in children. ⋯ The introduction of high-resolution portable ultrasound brought a great advance for the pediatric anesthesiologists; ultrasound-guided visualization of anatomic structures, in fact, allows greater precision of needle and catheter placement, and confirmation that the drug is deposited in the site of choice. This article reviews the safety and efficacy of central and perineural continuous infusions for postoperative pain control in children.