Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2011
ReviewInfluence of anesthesia on cerebral blood flow, cerebral metabolic rate, and brain functional connectivity.
To describe recent studies exploring brain function under the influence of hypnotic anesthetic agents, and their implications on the understanding of consciousness physiology and anesthesia-induced alteration of consciousness. ⋯ Accumulating evidence suggests that hypnotic anesthetic agents disrupt large-scale cerebral connectivity. This would result in an inability of the brain to generate and integrate information, while external sensory information is still processed at a lower order of complexity.
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Curr Opin Anaesthesiol · Oct 2011
ReviewPhantom limb pain and bodily awareness: current concepts and future directions.
Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management. ⋯ Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.
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Curr Opin Anaesthesiol · Oct 2011
ReviewLocal anesthetic systemic toxicity: update on mechanisms and treatment.
With increases in use of regional anesthesia, local anesthetic systemic toxicity (LAST) has been a topic of interest and debate. Despite many years of research, the exact cause and best treatment of LAST (particularly local anesthetic cardiotoxicity) remain unclear. This review will summarize what is known and what remains uncertain about LAST and its treatment, including information published in the past 12-18 months. ⋯ Regarding mechanism(s) of LAST, the evidence remains mixed, but it is likely that local anesthetic cardiotoxicity primarily arises from a blockade of sodium channels. As for treatment, in addition to ventilation, oxygenation, and chest compressions, lipid emulsion therapy should be a primary element in the treatment of cardiovascular LAST. The use of epinephrine and vasopressin should be tailored to specifics of an episode of LAST, and doses should be kept as low as possible while still achieving the desired effects.
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Regional anesthesia is evolving rapidly and increasing in popularity as evidenced by the large number of publications on the topic. In this healthcare environment, continual assessment of the safety and efficacy of clinical practice is critical. Neurologic complications of regional anesthesia can result in disability and are feared by patients and clinicians. Ultrasound guidance is unique as a nerve localizing technique in terms of being able to image needle-nerve proximity and potentially prevent direct trauma to nerves. This article reviews the recent literature relevant to neurologic complications of regional anesthesia. ⋯ The pathogenesis of perioperative nerve injury is complex with multiple potential etiologies and mechanisms. The role of intraneural injections as a modifiable risk factor for neurologic complications due to regional anesthesia remains topical. Relevant publications include studies on the morphology of peripheral nerves and risk of perioperative nerve injury in the context of both neuraxial anesthesia and PNB.
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Regional anesthesia is commonly used to provide intraoperative anesthesia and postoperative analgesia. Potential complications of both neuraxial and peripheral regional techniques include infectious sequelae. This review examines important components of practice that are known to minimize the risk of infection associated with regional anesthesia. ⋯ Infectious complications associated with regional anesthesia are exceedingly rare events. Adherence to strict aseptic guidelines as published by the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, and the Royal College of Anaesthetists may reduce the risk of infectious complications.