Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2019
ReviewFunctional anatomy of the nerve and optimal placement of the needle for successful (and) safe nerve blocks.
Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. ⋯ It is necessary to have a better understanding of what intraneural injection is when dealing with any type of nerve blocks, be that single nerve, plexuses, or the sciatic nerve. Perineural injections provide successful anesthesia without putting the nerve integrity at risk. That practice is supported by years of experience and common sense. Currently, there is no evidence to support any kind of intraneural injections, intrafascicular or extrafascicular.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewAnaesthesia for stroke thrombectomy: technical considerations based on outcome evidence.
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Treatment is time limited and delays cost lives. This review discusses modern stroke management, during a time when treatments and guidelines are rapidly evolving. ⋯ An individualized approach to the patient's anaesthetic management is optimal, and depends on close communication with the neurointerventionalist regarding patient and procedure-specific variables. No specific anaesthetic agent is preferred. Guiding principles are minimization of time delay, and maintenance of cerebral perfusion pressure.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewNeurological complications after cardiac surgery: anesthetic considerations based on outcome evidence.
Neurological complications after cardiac surgery remain prevalent. This review aims to discuss the modifiable and outcome-relevant risk factors based on an up-to-date literature review, with a focus on interventions that may improve outcomes. ⋯ The available evidence highlights the importance of maintaining optimal and individualized blood pressure, cerebral tissue oxygen saturation and hemoglobin level in improving neurological outcomes after cardiac surgery. However, outstanding issues remain and need to be addressed via outcome-oriented further research.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewRegional anesthesia and pain management in patients with sleep apnea: can they improve outcomes?
In several guidelines, regional anesthesia and analgesia have been suggested as safer alternatives for general anesthesia and systemic analgesia for their safety profile in patients suffering from obstructive sleep apnea (OSA). However, the underlying scientific basis is still evolving. The present review is intended to provide an up-to-date account on the question whether the use of regional anesthesia improves outcomes in patients with OSA. ⋯ Regional anesthesia can be recommended as a good strategy to treat patients with OSA whenever feasible, as it reduces the incidence of potentially catastrophic perioperative complications. However, the breadth of both surgical and regional anesthetic techniques analyzed is limited; further research should focus on extending the knowledge base beyond neuraxial anesthesia and orthopedics.