Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2023
ReviewInnovations in diagnostic and treatment options for pediatric epilepsy and their anesthetic implications.
To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients. ⋯ The number of diagnostic and treatment options being used for the management of pediatric epilepsy has increased significantly. In the past few years, a handful of articles have been published, which describe the anesthetic considerations for these procedures. These studies are helpful to anesthesiologists who are planning an upcoming anesthetic or who are developing a 'best practice' model for their institution. Because unlike other diagnostic studies, failure to understand what effects anesthetics have on the brain, may negate the utility of the study. Although these new findings can be used to provide some anesthesia practice recommendations for epilepsy procedures in which the best management is still unclear, additional high-quality studies are needed.
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Curr Opin Anaesthesiol · Oct 2023
ReviewAdvances in the management of persistent pain after total knee arthroplasty.
Total knee arthroplasty (TKA) is one of the most commonly performed surgical procedures, with additional growth anticipated as the US population ages. Because the prevalence of chronic postsurgical pain ranges from 15 to 25%, identifying persons at risk for persistent pain following surgery allows for preoperative optimization of risk factors as well as early identification and intervention in the postsurgical period. ⋯ Identification and early intervention to address persistent pain after TKA is important to optimize patient outcomes. The anticipated growth in TKA underscores the need for future investigations to more fully define potential therapies for chronic pain following TKA.
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Curr Opin Anaesthesiol · Oct 2023
ReviewMaking chronic pain count: empirical support for the ICD-11 classification of chronic pain.
The purpose is to review the evidence that has been collected with regard to the new classification of chronic pain. In 2022, the World Health Assembly endorsed the 11 th revision of the International Classification of Diseases and Related Health Problems (ICD-11), and with it a new classification of chronic pain. ⋯ The evidence supports the use of the new classification and highlights its informational gains - using it will contribute to making chronic pain count in many contexts.
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Curr Opin Anaesthesiol · Oct 2023
ReviewChronic post amputation pain: pathophysiology and prevention options for a heterogenous phenomenon.
Chronic postamputation pain (cPAP) remains a clinical challenge, and current understanding places a high emphasis on prevention strategies. Unfortunately, there is still no evidence-based regimen to reliably prevent chronic pain after amputation. ⋯ Phantom limb pain is a multifactorial process involving profound functional and structural changes in the peripheral and central nervous system. These changes interact with individual medical, psychosocial and genetic patient risk factors. The patient collective of amputees is very heterogeneous. Available evidence suggests that efforts should focus on prevention of phantom limb pain, since treatment is notoriously difficult. Questions as yet unanswered include the evidence-base of specific analgesic interventions, their optimal "window of opportunity" where they may be most effective, and whether patient stratification according to biopsychosocial risk factors can help guide preventive therapy.
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Curr Opin Anaesthesiol · Oct 2023
ReviewDiagnosing delirium in perioperative and intensive care medicine.
This article reviews the current literature on instruments used for screening and diagnosing delirium in perioperative and intensive care medicine. It summarizes recent findings to guide clinicians and researchers in choosing the most appropriate tools. ⋯ Overlooking or misdiagnosing delirium may result in poor patient outcomes. Familiarizing healthcare workers with the variety of delirium assessments and selecting the most appropriate tool to their needs is an important step toward improving awareness and recognition of delirium.