Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2022
Review Meta AnalysisSalted or sweet? Hypertonic saline or mannitol for treatment of intracranial hypertension.
The aim of this review article is to present current recommendations regarding the use of hypertonic saline and mannitol for the treatment of intracranial hypertension. ⋯ Identifying and treating increased intracranial pressure is imperative in neurocritical care settings and proper management is essential to improve long-term outcomes. Currently, there is insufficient evidence from comparative studies to support a formal recommendation on the use of any specific hyperosmolar medication in patients with acute increased intracranial pressure.
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Curr Opin Anaesthesiol · Oct 2022
ReviewHyperlactatemia and other perioperative metabolic disturbances in neuroanesthesia.
The concept of 'brain-body cross-talking' has gained growing interest in the last years. The understanding of the metabolic disturbances (e.g., hypernatraemia/hyponatraemia and hyperlactatemia) in neurosurgical patients has improved during the last years. ⋯ These findings will contribute to a better understanding of the pathophysiology involved and enable better prevention and therapy where possible in clinical practice.
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Curr Opin Anaesthesiol · Oct 2022
ReviewUse of regional analgesia to prevent the conversion from acute to chronic pain.
Chronic post-surgical pain (CPSP) prevalence has not changed over the past decades what questions the efficacy of preventive strategies. Regional analgesia is used to control acute pain, but preventive effect on CPSP remains debated. Failures and future application of regional analgesia to prevent transition from acute to chronic pain will be discussed. ⋯ Regional analgesia failure to prevent CPSP development should prompt us to reconsider its perioperative utilization. Patients' stratification, for example high-pain responders, might help to target those who will most benefit of regional analgesia. The impact of regional analgesia on secondary pain-related outcomes such as intensity and neuropathic character despite no difference on CPSP incidence requires more studies. Finally, the preventive effect of regional analgesia targeted interventions on CPSP in patients suffering from severe subacute pain deserves to be assessed.
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Curr Opin Anaesthesiol · Oct 2022
ReviewRegional versus general anesthesia for ambulatory total hip and knee arthroplasty.
With the removal of both total knee and total hip arthroplasty from the Centers for Medicare and Medicaid Services' inpatient-only list, efforts to improve efficiency of the perioperative management of total joint patients have increased recently. The publication of several recent studies examining the impact of anesthesia type on outcomes has prompted the need to review the overall state of evidence for spinal versus general anesthesia for outpatient total joint arthroplasty. ⋯ The type of anesthesia used for total joint arthroplasty may have an important effect on outcomes. Until randomized control trials are performed we must rely on existing evidence, which suggests that both spinal and general anesthesia can lead to successful outcomes after ambulatory total joint arthroplasty.
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The aim of this review is to provide a practical and updated summary on healthcare-associated central nervous system infections and their management. ⋯ Clinicians should maintain a high index of suspicion for healthcare-associated central nervous system infections in patients with specific risk factors (i.e. recent neurosurgery, cerebrospinal shunts, drains or implantable devices, head/spinal traumatic events), taking into account systemic signs, and alterations in microbiological, imaging, cerebrospinal fluid findings. The diagnosis is often difficult to confirm because of reduced levels of consciousness or coma. Both Gram-positive and Gram-negative (often multidrug-resistant or even pandrug-resistant) microorganisms may be the cause. Selection of antibiotics must consider susceptibility and penetration into the central nervous system. Ineffective treatments are frequent, and mortality can reach 60%. Future research should focus on the diagnostic performance of biomarkers and on the use of novel antimicrobial regimens, especially for the treatment of difficult to treat infections.