Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2017
ReviewNew advancements in spinal cord stimulation for chronic pain management.
To update the recent development of spinal cord stimulation (SCS) technology in the management of chronic pain. ⋯ HF-10 SCS is free of paresthesia and associated with significantly better coverage of axial lower back pain. Burst stimulation invokes minimal paresthesia and provides better coverage of low back pain. DRG stimulation results in better outcomes in patients with complex regional pain syndrome. It requires less energy and delivers consistent stimulation regardless of postural variations. Clinical trials with new SCS modalities, such as Stimwaves, are under way to make SCS wireless. Intraoperative neuromonitoring and paresthesia atlas may be used to guide lead placement. Multicolumn surgical paddle leads enable a combination of independent current control with up to 32 contacts for better programming and better coverage.
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Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. ⋯ Epidural analgesia for obstetric analgesic purposes is considered to be well tolerated in young, healthy women, since efficacy has been proven and complications leading to permanent neurological damage seldomly occur. Safety of epidural analgesia for perioperative and chronic pain treatment is more difficult to balance; careful selection of appropriate patients cannot be over-emphasized.
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Curr Opin Anaesthesiol · Dec 2017
ReviewHeart rate variability: implications for perioperative anesthesia care.
Heart rate variability (HRV) is a measure of the balance between both the parasympathetic and sympathetic nervous system and may provide useful information for anesthesia care providers. HRV may offer predictive information about critically ill and operative patients. Further, HRV collection provides real-time information of patient autonomic nervous system status and may allow tailoring of the analgesia for patients in the ICU and operating room. ⋯ Not applicable.
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Curr Opin Anaesthesiol · Dec 2017
ReviewClinical update regarding general anesthesia-associated neurotoxicity in infants and children.
The U.S. Federal Drug Administration (FDA) recently released a warning stating that 'repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children's brains' (www.fda.gov/ucm582356.htm). The goal of this article is to review the most recent clinical studies which provide evidence that these concerns may be overstated for the majority of healthy young children who require surgery and anesthesia. ⋯ These findings suggest that anesthetic neurotoxicity is not a major contributory pathway for adverse neurodevelopmental outcomes in the majority of healthy children who require surgery before 3 years of age. Future work should focus on the particular vulnerabilities of the fetus, premature infant, and children with developmental disabilities, major congenital, cardiac or neurological abnormalities not specifically addressed by these studies.
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Curr Opin Anaesthesiol · Dec 2017
ReviewDifficult airway management and training: simulation, communication, and feedback.
Successful and sustainable training and learning of the management of difficult and normal airway is essential for all clinically active anesthesiologists. We emphasize the importance of a continuously updated learning and training environment based on actual knowledge, best available equipment, standardized procedures, and educational theory. ⋯ We present the details of the Zurich Airway Training and Simulation program, which has been constantly updated to the actual state of knowledge and available equipment.