Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2016
ReviewAdjunct analgesic drugs to local anaesthetics for neuroaxial blocks in children.
This article reviews various adjunct drugs used in the context of neuroaxial blocks in children and to provide a literature and evidence-based suggestion for the rational use of such adjuncts. ⋯ Alpha-2 adrenoceptor agonists currently represent the most versatile and well-tolerated adjunct for neuroaxial blockade in children. Preservative-free morphine may be indicated in certain situations but the risk for respiratory depression and other disturbing side-effects must be taken into account. Preservative-free ketamine is an effective adjunct to caudal blockade in children but the use should be restricted to children older than 1 year of age. All other drugs must still be regarded as experimental and should not be used outside clinical trials.
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Curr Opin Anaesthesiol · Oct 2016
ReviewUltrasound indications for chronic pain management: an update on the most recent evidence.
The ability of ultrasound to provide detailed anatomic visualization while avoiding radiation exposure continues to make it an appealing tool for many practitioners of chronic pain management. This review will present the most recent evidence regarding the use of ultrasound-guidance for the performance of interventional procedures in the treatment of chronic pain. ⋯ Despite continued interest in ultrasound-guided techniques for chronic pain management procedures, the evidence is still limited mainly to small, randomized trials and case series. For some procedures, such as stellate ganglion block and peripheral joint injections, recent evidence appears to be tilting in favor of ultrasound-guidance as the preferred technique, though fluoroscopy continues to be a much more reliable method for detection of intravascular uptake of injectate.
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The aim of the review is to examine the possible benefit of regional anaesthesia in four areas of perioperative care. These are: the relationship between anaesthesia and cancer recurrence; the effects of regional anaesthesia in orthopaedic surgery; its use in people with obstructive sleep apnoea syndrome; and its potential for preventing chronic postsurgical pain. ⋯ There is at present little unequivocal, high-quality evidence to confirm clear superiority of regional anaesthesia over general anaesthesia for any of the conditions described in this article. Perhaps as important as the choice of technique is the practitioner's skill and attention to detail; in addition, the major contributor to perioperative risk remains the patient and his/her pre-existing condition.
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Curr Opin Anaesthesiol · Oct 2016
ReviewIntraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanaesthesia procedures.
This review reports recent evidence on intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanaesthesia procedures. ⋯ Recent studies provide interesting evidence of intraoperative monitoring of NIRS, brptiO2 and BIS. The brptiO2/PaO2 ratio is much more reliable than an absolute brptiO2 reading; NIRS helps clinicians to monitor patients who are undergoing endovascular treatment, and BIS guides the titration of anaesthesia during awake craniotomy; its values are not affected by the presence of a frontal brain tumour.
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Curr Opin Anaesthesiol · Oct 2016
ReviewRecent trends in the anesthetic management of craniotomy for supratentorial tumor resection.
The article reviews the recent evidence on the anesthetic management of patients undergoing craniotomy for supratentorial tumor resection. ⋯ Recent evidence has yielded valuable information regarding anesthetic management of patients undergoing supratentorial tumor craniotomy. Despite a plethora of studies that compare short-term outcomes using different anesthetic and analgesic regimens, randomized controlled trials that examine the long-term outcomes (i.e., neurocognitive function, quality of life, tumor recurrence, and survival) that are of particular interest to patients are needed.