Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2014
ReviewAnesthesia for intracranial surgery in infants and children.
Age-related differences in the surgical lesions, anatomy and physiological responses to surgery and anesthesia underlie the clinically relevant differences between pediatric patients and their adult counterparts. Anesthesiologists need to be aware of the unique challenges in the anesthetic management of the pediatric neurosurgical patient. ⋯ The aim of this review is to highlight the impact of these techniques on the intraoperative management of the pediatric neurosurgical patient. These issues are essential in minimizing perioperative morbidity and mortality.
-
Robots in regional anesthesia are used as a tool to automate the performance of regional techniques reducing the anesthesiologist's workload and improving patient care. The purpose of this review is to show the latest findings in robotic regional anesthesia. ⋯ Robots can improve the performance and safety in regional anesthesia. In this review, we present the developments made in robotic and automated regional anesthesia, and discuss the current state of research in this field.
-
Curr Opin Anaesthesiol · Oct 2014
ReviewRegional anesthesia in patients with pre-existing neurologic disease.
Regional anesthesia is controversial in patients with pre-existing neurologic disease. This study reviews the published evidence regarding the utilization and outcomes of regional anesthetics in this population. ⋯ Regional anesthesia can be safely utilized in patients with pre-existing neurological disease and may have benefits over general anesthesia; however, a conservative approach is warranted. In addition, further publications regarding regional techniques in this population are needed.
-
Pain following total knee arthroplasty is a challenging task for healthcare providers. Concurrently, fast recovery and early ambulation are required to regain function and to prevent postoperative complications. Ideal postoperative analgesia provides sufficient pain relief with minimal opioid consumption and preservation of motor strength. Regional analgesia techniques are broadly used to answer these expectations. Femoral nerve blocks are performed frequently but have suggested disadvantages, such as motor weakness. The use of lumbar epidurals is questioned because of the risk of epidural hematoma. Relatively new techniques, such as local infiltration analgesia or adductor canal blocks, are increasingly discussed. The present review discusses new findings and weight between known benefits and risks of all of these techniques for total knee arthroplasty. ⋯ Femoral nerve blocks are still the gold standard for an effective analgesia approach in knee arthroplasty and should be supplemented (if needed) by oral opioids. An additional sciatic nerve blockade is still controversial and should be an individual decision. Large-scale studies are needed to reinforce the promising results of newer regional techniques, such as local infiltration analgesia and adductor canal block.
-
Chronic pain is often accompanied by mood, sleep and cognitive complications affecting the patient's quality of life. This reviews aims to provide a synthesis of the recent clinical and preclinical findings concerning the chronic pain and mood disorder comorbidity. ⋯ The epidemiological studies report a high prevalence of mood disorders in patients with chronic pain, and these consequences of pain can be preclinically modeled. This comorbidity may be explained by shared morphological and functional alterations observed in both chronic pain and mood disorders. However, mechanistic studies also highlight differences in such alterations depending on the type of chronic pain. Better understanding of the genetic and environmental determinants of pain-induced mood disorders and of the various neurobiological bases of this comorbidity depending on the pain subtype could provide the clinician with important diagnosis and treatment tools. Such progress benefits from translational effort between clinical and preclinical research.