Current opinion in anaesthesiology
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A series of recent studies have changed the practice of pediatric neuroanesthesia, improving outcomes and making children's quality of life better. ⋯ Although neurosurgical anesthesia research in the pediatric population can be ethically and logistically complex, resolving questions such as the optimal blood pressure during surgery and best management of infants undergoing repair of craniosynostosis will improve patient outcomes.
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Connectivity is a technique that uses functional MRI (fMRI) to explore global brain function in healthy and diseased states. Connectivity is now being studied as a part of global brain function in major national and international studies. It is, therefore, timely to review its relevance to anaesthesia. ⋯ Higher mental function related networks such as the DMN, the executive control network and salience are more sensitive to anaesthesia. In geriatric patients, the DMN is impaired, which affects cognition. Hence, the combined effect of age and anaesthesia in elderly on mental function can cause significant postoperative cognitive impairment.
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Curr Opin Anaesthesiol · Oct 2015
ReviewAcute pain assessment tools: let us move beyond simple pain ratings.
This review highlights challenges and current trends in tools used to assess acute pain across the lifespan. ⋯ Valid and pragmatic assessment of pain is essential for effective pain management. Unidimensional scales that capture self-reported pain intensity ratings undervalue to the complexity of the pain experience. Pain is a biopsychosocial experience and assessment is a complex social transaction and an exchange of the meaning of pain that demands a more comprehensive approach.
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Increased understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. This review addresses the many systemic complications of TBI that make achieving these targets challenging and can influence outcome. ⋯ Effective management of TBI should go beyond formulaic-based pursuit of physiological targets and requires a detailed understanding of the multisystem response of the body.
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Gender differences are well known in clinical pain and pain-related diseases. However, studies analyzing gender differences in postoperative pain yielded inconsistent finding. The aim of this review was to summarize recent findings on this matter. ⋯ Women seem to be at higher risk to develop severe postoperative pain but gender differences seem to be small and of low clinical relevance. We argue that major confounders may explain discrepancies between studies. Large prospective studies and registry data assessing gender aspects including confounders need to be done in the future.