Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2019
ReviewAnesthesia and brain tumor surgery: technical considerations based on current research evidence.
Anesthetics may influence cancer recurrence and metastasis following surgery by modulating the neuroendocrine stress response or by directly affecting cancer cell biology. This review summarizes the current evidence on whether commonly used anesthetics potentially affect postoperative outcomes following solid organ cancer surgery with particular focus on neurological malignancies. ⋯ Further work at both the basic science and clinical level is urgently needed to evaluate the association between perioperative factors, including anesthetics/technique, and postoperative brain tumor outcomes.
-
Persistent postoperative pain (PPP) is a significant source of morbidity in our population. An excellent opportunity to understand the transition from acute to chronic pain states. Understanding the mechanisms that drive this and modulators that influence this transition is essential to both prevent and manage this condition. ⋯ Persistent maladaptive neuroplastic changes secondary to neurotrophic factors and interactions between neurons and microglia may well explain the phenomenon. This article reviews the current thought processes on mechanisms and modulators from a basic science and epidemiological perspective.
-
Curr Opin Anaesthesiol · Oct 2019
ReviewNeurophysiological monitoring during neurosurgery: anesthetic considerations based on outcome evidence.
This article reviews the recent outcome studies that investigated intraoperative neurophysiological monitoring (IONM) during spine, neurovascular and brain tumor surgery. ⋯ For neurosurgical procedures that can be complicated by neural injury, the use of IONM should be considered according to specific patient and surgical factors. Future studies should focus on improving IONM technology and optimizing sensitivity and specificity for detecting any impending neural damage.
-
The clinical practice of anesthesia continues to evolve and grow toward increasing quality and safety while improving the patient and family perioperative experience. Within the realm of pediatric anesthesia, advances in regional anesthesia techniques are important part in this aim. ⋯ Large data sets have given clinical providers information into the practice of regional anesthesia. It has confirmed the safety of common regional anesthetic techniques in addition to providing guidance to improving outcomes for children.