Current opinion in anaesthesiology
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Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology. ⋯ DBS is a robust surgical treatment for a variety of neurological disorders. Appropriate anaesthetic agents that achieve patient comfort without interfering with electrophysiology are paramount.
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Effective analgesia is necessary for optimal recovery after surgery, but children often do not attain adequate postoperative pain control. This review examines the current trends in paediatric regional anaesthesia. ⋯ By using a multimodal approach that includes regional anaesthesia, paediatric pain management should aim to reduce patients' pain to an acceptable level without compromising their degree of mobilization. Undoubtedly, peripheral nerve blocks improve analgesia, but future large prospective studies should be conducted to further delineate their effectiveness, duration and safety.
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Ultrasound guidance is frequently utilized for needle placement and observation of local anesthetic spread when performing peripheral nerve blocks. Although there is evidence that ultrasound technology can reduce complications, there are limitations to 2-dimensional (2-D) ultrasound. Three-dimensional (3-D) and especially real-time 3-D (4-D) ultrasound may allow for optimized and well tolerated needle positioning and enhanced observation of local anesthetic spread around the target structure. This article reviewed the current literature regarding the use of 3-D and 4-D ultrasound technology in a regional anesthesia setting. ⋯ At present, there are limited data regarding the use of 3-D ultrasound and a complete lack of randomized controlled clinical trials evaluating the potential benefits of real-time 3-D (4-D) ultrasound. This may be in part due to technical limitations associated with these techniques.
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Curr Opin Anaesthesiol · Oct 2015
ReviewTraumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU.
Over many years, 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. The present review revisits the evidence for these targets and therapies. ⋯ Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.