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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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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Every year, millions of children undergo anesthesia. Emerging evidence from experimental in-vitro and in-vivo models supports a role for neuropathologic injury and neurobehavioral deficits at older age after early exposure to various anesthetic regimens. Clinical studies have sought to identify a phenotype of developmental anesthesia neurotoxicity in humans, but the current evidence is limited to data from retrospective studies with their associated confounders. Experimental models have been used to further define the injury and to help identify potential mechanisms of this neurotoxicity. ⋯ Whether anesthesia-associated neurotoxicity affects the developing human brain and whether this leads to clinically measurable deficits remains unclear.