Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2012
ReviewAnesthetic management for intra-arterial therapy in stroke.
Efforts in intra-arterial treatment of acute ischemic stroke mainly focus on new devices to reperfuse ischemic brain. Equally, if not more important is the anesthesiologists' role in controlling the consciousness level as well as anxiety, movement, airway and respiration and hemodynamic parameters and in a nutshell the safety of patients in a timely manner. We find paucity in studies designed to show the ideal method, level of anesthesia and optimal hemodynamic parameters for these. This review is designed to relate current thought process and debate on the best anesthetic method for this population. ⋯ Current literature review on anesthetic considerations of intra-arterial treatment of acute ischemic stroke emphasizes the need for well designed prospective studies to demonstrate the role of anesthetics in brain protection if any as well as define a suitable sedation method and guidelines for hemodynamic parameters.
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Chronic postsurgical pain (CPSP) is the consequence of acute postoperative pain. Unfortunately, despite many attempts of improvement, the treatment of acute postoperative pain remains unsatisfactory. In the present review, the probable reasons for this will be reviewed. ⋯ A single treatment approach is almost unlikely to solve the problem of CPSP. Consequently, the management of postoperative pain has to become more patients' specific and etiologies sensitive.
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Curr Opin Anaesthesiol · Oct 2012
ReviewProtecting the brain during neurosurgical procedures: strategies that can work.
The quest for neuroprotection strategies during periods of neuronal vulnerability persists despite decades of basic and clinical research. This review will focus on the latest developments in the area of clinical brain protection with the major emphasis on strategies that can be beneficial during neurosurgical procedures. ⋯ The findings of this review suggest that the anaesthesiologist is compelled to use nonpharmacological strategies sometimes based on empiric evidence to protect the brain during neurosurgical procedures. These strategies are simple, have high benefit/risk ratios and are inexpensive. Rigorous controlled clinical studies are needed to investigate the neuroprotective efficacy of these commonly used nonpharmacological methods.
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Cerebrovascular disease is a common cause of death and disability worldwide. The current literature supports an association between blood pressure (BP) and patient outcome during acute stroke. This review will provide an overview of the evidence to guide BP management during acute stroke. ⋯ Both hypertension and hypotension are associated with worse outcomes during acute stroke; however, the optimal hemodynamic parameters are not clearly defined in this patient population. Despite active research, there is a lack of high-quality data guiding current BP management in stroke. Several trials currently underway may clarify the many existing questions on this topic.
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Approximately 100 million people suffer from chronic pain in the USA. Opioid medications are commonly prescribed to treat pain, but are becoming the most widely misused controlled substance nationally. Physicians who treat patients with chronic pain must be cognizant of the federal and state policies that govern the distribution of opioid medications as well as the current standards of medical practice for opioid prescribing. ⋯ The problems of undertreated pain and the epidemic of prescription drug abuse have coincided, creating a need for medical and social policy that protects society and access to appropriate care for those in pain. Federal and state laws are in evolution, and clinicians must remain aware of these changes as well as the issues behind them that will impact safe and appropriate care of patients in pain.