Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2014
ReviewPostoperative ICU management of patients after subarachnoid hemorrhage.
This article reviews recent advances in the postoperative ICU management of patients after subarachnoid hemorrhage (SAH), especially with regards to hemodynamic management, methods of improving neurological outcomes, and management of cardiac and pulmonary complications. ⋯ The postoperative ICU period after SAH is associated with a significant morbidity and mortality risk, and recent studies have greatly contributed to our understanding of how to optimally manage these patients.
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Curr Opin Anaesthesiol · Oct 2014
ReviewSpinal anesthesia revisited: toxicity of new and old drugs and compounds.
Neural toxicity of substances injected into the intrathecal space has been a matter of debate since the introduction of spinal anesthesia in clinical practice. In recent years, new local anesthetics and adjuvants have been proposed for intrathecal use, and new techniques such as the use of ultrasound have been propagated. The present review summarizes recent clinical and experimental data on the neurotoxic effects of drugs and substances used for or in conjunction with spinal anesthesia. ⋯ Clinical data suggest a high safety profile for intrathecal drugs and substances used for or in conjunction with spinal anesthesia. Recent experimental models for toxicity have provided further insight into the mechanisms and demonstrated possible, albeit clinically small differences in the relative neurotoxic potential of intrathecal drugs. This may contribute to a further increase in the safe use of spinal anesthesia in the clinical setting.
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Curr Opin Anaesthesiol · Oct 2014
ReviewDiagnosis, mechanisms and treatment of complex regional pain syndrome.
The incidence and disease course of complex regional pain syndrome (CRPS) has been unclear until recently. This was due to inconsistent diagnostic criteria used in previous studies and a lack of large-scale prospective datasets. Multiple mechanisms of CRPS have been suggested, and recent research has begun to explain how inflammation, the immune system and the autonomic nervous system may interact with aberrant central neuroplasticity to produce the clinical picture. This review summarizes progress in these fields. ⋯ Recent findings in diverse research fields suggest novel treatment options for CRPS: from targeting autoimmunity to correcting abnormal body image. Many of the advances in our understanding of CRPS have arisen from the development of collaborative research efforts, such as the TREND group in the Netherlands.
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Anemia is common in neurosurgical patients, and is associated with secondary brain injury. Although recent studies in critically ill patients have shifted practice toward more restrictive red blood cell (RBC) transfusion strategies, the evidence for restrictive versus liberal transfusion strategies in neurosurgical patients has been controversial. In this article, we review recent studies that highlight issues in RBC transfusion in neurosurgical patients. ⋯ There is a lack of definitive evidence to guide RBC transfusion practices in neurosurgical patients. Large randomized control trials are needed to better assess when and how aggressively to transfuse RBCs in neurosurgical patients.
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This review highlights new data and current trends of well tolerated and effective paediatric regional anesthesia. Historically, the practice of paediatric regional anesthesia was based largely on information from adult studies, but recent literature contains information on paediatric specific risks and benefits of old and new techniques as well as the impact of new ideas and technologies. ⋯ Paediatric specific data for regional anesthesia are available to help guide optimal pain management. The paediatric regional anesthesia literature lags behind literature available for adult populations and increased studies are needed for additional information for informed decision-making.