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
ReviewFrom basic concepts to emerging technologies in regional anesthesia.
The present article details how our understanding of the basic concepts of regional anesthesia has recently evolved. We will appraise current technological advances and question the commensurate nature of the relationship between tradition and innovation. ⋯ Over the past decade, our understanding of the fundamental concepts of regional anesthesia continues to be challenged by emerging experimental and clinical evidence.
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Curr Opin Anaesthesiol · Oct 2010
ReviewIs nitrous oxide use appropriate in neurosurgical and neurologically at-risk patients?
To address controversial issues surrounding the use of nitrous oxide as a component of anesthesia in neurosurgical and neurologically at-risk patients. ⋯ Except in a few specific circumstances, there exists no conclusive evidence to support the dogmatic avoidance of nitrous oxide in neurosurgical patients.
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Endoscopic neurosurgical procedures are becoming more frequent and popular in the treatment of intracranial disease. When endoscopy involves the intraventricular structures, irrigating solutions are required and may contribute to sudden and sharp increases in intracranial pressure. More recently, nasal endoscopic approach has been used to perform skull base surgery for aneurysms and tumours. We have analysed published articles in order to detect anaesthesia management and perioperative complications. ⋯ Invasive arterial blood pressure and intracranial pressure should be measured continuously during neuroendoscopies to detect early intraoperative cerebral ischaemia instead of waiting for the appearance of bradycardia which may be a late sign. General anaesthesia remains the technique of choice. Intracranial haemorrhage increases the likelihood of perioperative complications. Close postoperative monitoring is required to diagnose and treat complications such as convulsions, persistent hydrocephalus, haemorrhage or electrolytic imbalance.