Current opinion in anaesthesiology
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Connectivity is a technique that uses functional MRI (fMRI) to explore global brain function in healthy and diseased states. Connectivity is now being studied as a part of global brain function in major national and international studies. It is, therefore, timely to review its relevance to anaesthesia. ⋯ Higher mental function related networks such as the DMN, the executive control network and salience are more sensitive to anaesthesia. In geriatric patients, the DMN is impaired, which affects cognition. Hence, the combined effect of age and anaesthesia in elderly on mental function can cause significant postoperative cognitive impairment.
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As the increased use of new oral anticoagulants may put patients at particular risk of bleeding, experts suggested strategies to perform neuraxial anesthesia as well tolerated as possible. This review summarizes different approaches. ⋯ A simplified approach covering recent recommendations is given which may aid well tolerated use of neuraxial blocks in patients taking new oral anticoagulants.
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A series of recent studies have changed the practice of pediatric neuroanesthesia, improving outcomes and making children's quality of life better. ⋯ Although neurosurgical anesthesia research in the pediatric population can be ethically and logistically complex, resolving questions such as the optimal blood pressure during surgery and best management of infants undergoing repair of craniosynostosis will improve patient outcomes.
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Curr Opin Anaesthesiol · Oct 2015
ReviewTraumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU.
Over many years, understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. The present review revisits the evidence for these targets and therapies. ⋯ Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.
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Gender differences are well known in clinical pain and pain-related diseases. However, studies analyzing gender differences in postoperative pain yielded inconsistent finding. The aim of this review was to summarize recent findings on this matter. ⋯ Women seem to be at higher risk to develop severe postoperative pain but gender differences seem to be small and of low clinical relevance. We argue that major confounders may explain discrepancies between studies. Large prospective studies and registry data assessing gender aspects including confounders need to be done in the future.