Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2023
ReviewMotor-sparing peripheral nerve blocks for hip and knee surgery.
To summarize the recent literature describing and comparing novel motor-sparing peripheral nerve block techniques for hip and knee surgery. This topic is relevant because the number of patients undergoing same day discharge after hip and knee surgery is increasing. Preserving lower extremity muscle function is essential to facilitate early physical therapy for these patients. ⋯ The use of motor-sparing peripheral nerve block techniques enables early ambulation, adequate pain control, and avoidance of opioid-related side effects facilitating outpatient/ambulatory lower extremity surgery. Further studies of these techniques for continuous peripheral nerve block catheters are needed to assess if extended blockade continues to provide motor-sparing and opioid-sparing benefits.
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Curr Opin Anaesthesiol · Oct 2023
ReviewAnesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery.
This article delves into recent advances in same-day neurosurgery (SDNS), specifically concerning indications, perioperative protocol, safety, and outcomes. Additionally, it explores the recent updates on awake craniotomy and awake spine surgery. ⋯ SDNS offers promising prospects for patients and healthcare providers alike, with the potential to provide well tolerated, efficient, and cost-effective neurosurgical care in carefully selected cases.
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Curr Opin Anaesthesiol · Oct 2023
ReviewModulating anesthetic emergence with pathway-selective dopamine signaling.
To summarize the recent preclinical findings investigating dopaminergic circuits for their involvement in reversing anesthetic-induced unconsciousness. ⋯ Potential avenues for accelerating anesthetic emergence may be found through targeting specific arousal-promoting pathways in the brain. Accumulating evidence from rodent studies manipulating cell type- and circuit-specific signaling pathways have identified dopamine as a potent modulator of general anesthesia. Specifically, dopamine signaling along the mesolimbic and mesocortical pathways plays a fundamental role in regulating consciousness.
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Curr Opin Anaesthesiol · Oct 2023
ReviewGeneral purpose models for intravenous anesthetics, the next generation for target-controlled infusion and total intravenous anesthesia?
There are various pharmacokinetic-dynamic models available, which describe the time course of drug concentration and effect and which can be incorporated into target-controlled infusion (TCI) systems. For anesthesia and sedation, most of these models are derived from narrow patient populations, which restricts applicability for the overall population, including (small) children, elderly, and obese patients. This forces clinicians to select specific models for specific populations. ⋯ This article examines the usability of these general-purpose models in relation to the more traditional models.