Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2013
ReviewAssessment and management of rib fracture pain in geriatric population: an ode to old age.
Pain management for traumatic rib fractures has been described in literature, but there is paucity of data when it comes to acute pain management in the elderly, let alone pain resulting from traumatic rib fractures. ⋯ The goal is to devise a proper pain management regimen for geriatric patients with rib fractures to decrease the morbidity and mortality associated with it. Developing institutional protocols is one step forward towards quality care for such patients.
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Pituitary tumors are commonly encountered in clinical practice. Patients with functioning adenomas frequently present with symptoms of hormone excess, whereas those with nonfunctioning adenomas often present later and have symptoms resulting from mass effect of the tumor. This article examines recent advancements in the preoperative assessment and anesthetic management of patients undergoing transsphenoidal pituitary surgery. ⋯ Anesthetic management for pituitary surgery requires thorough preanesthetic assessment of hormonal function and intraoperative management to facilitate surgical exposure while providing hemodynamic stability and allowing for rapid emergence.
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Curr Opin Anaesthesiol · Oct 2013
ReviewThe new technological trends in ultrasound-guided regional anesthesia.
Real-time two-dimensional ultrasound guidance is undoubtedly one of the most important evolutions in the field of regional anesthesia techniques, for peripheral nerve blocks and neuraxial anesthesia. The recent literature has been analyzed for studies concerning new technological trends in ultrasound-guided regional anesthesia. This review focuses on electromagnetic tracking systems for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia. ⋯ This article describes the principles, technology and development of electromagnetic tracking system for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia, considering whether these new technologies will have impending applications in clinical practice.
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It is generally accepted that carotid endarterectomy (CEA) reduces the risk of stroke in symptomatic patients, with less risk reduction for asymptomatic patients. Although the comorbidities of these patients combined with the hemodynamic goals for the procedure pose unique perioperative challenges, patients undergoing CEA attain excellent outcomes. Nonetheless, heightened focus on perioperative management of comorbidities is increasingly important as older and more complex patients present with carotid artery disease. Although controversial, the efficacy, safety, and durability of carotid angioplasty and stenting (CAS) have been better defined in recent years. The 2012 literature presents several developments in the anesthetic management of CEA. Selected publications regarding CAS are also reviewed. ⋯ Patients with significant comorbidities may be managed safely by a variety of anesthetic techniques. Maintaining focus on physiologic management, and monitoring the brain remain important goals of perioperative management. Recent data suggest that the durability and safety of CAS are not inferior to those of CEA.
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The purpose of this review is to provide an update on the diagnosis, treatment, and prevention of neuropathic pain. ⋯ The literature reveals that neuropathic pain is underdiagnosed and often undertreated or treated with ineffective or untested modalities. Evolving definitions of neuropathic pain has broadened the range of therapeutic approaches and brought current treatment paradigms under increased scrutiny. The lack of a mechanism-based approach to treatment may be responsible for the lackluster responses seen in most neuropathic pain conditions.