Current opinion in anaesthesiology
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Robots in regional anesthesia are used as a tool to automate the performance of regional techniques reducing the anesthesiologist's workload and improving patient care. The purpose of this review is to show the latest findings in robotic regional anesthesia. ⋯ Robots can improve the performance and safety in regional anesthesia. In this review, we present the developments made in robotic and automated regional anesthesia, and discuss the current state of research in this field.
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Curr Opin Anaesthesiol · Oct 2014
ReviewRegional anesthesia in patients with pre-existing neurologic disease.
Regional anesthesia is controversial in patients with pre-existing neurologic disease. This study reviews the published evidence regarding the utilization and outcomes of regional anesthetics in this population. ⋯ Regional anesthesia can be safely utilized in patients with pre-existing neurological disease and may have benefits over general anesthesia; however, a conservative approach is warranted. In addition, further publications regarding regional techniques in this population are needed.
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Postoperative pain remains poorly treated in many patients. One reason is the inadequate use of nonopioid analgesics. This review examines the most recent findings on nonopioid analgesics and how these translate into clinical practice. ⋯ Nonopioid analgesics are important components of multimodal postoperative analgesia. The selection of the most appropriate compound for an individual patient can be based more and more on ever increasing data on these important analgesics.
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Pain following total knee arthroplasty is a challenging task for healthcare providers. Concurrently, fast recovery and early ambulation are required to regain function and to prevent postoperative complications. Ideal postoperative analgesia provides sufficient pain relief with minimal opioid consumption and preservation of motor strength. Regional analgesia techniques are broadly used to answer these expectations. Femoral nerve blocks are performed frequently but have suggested disadvantages, such as motor weakness. The use of lumbar epidurals is questioned because of the risk of epidural hematoma. Relatively new techniques, such as local infiltration analgesia or adductor canal blocks, are increasingly discussed. The present review discusses new findings and weight between known benefits and risks of all of these techniques for total knee arthroplasty. ⋯ Femoral nerve blocks are still the gold standard for an effective analgesia approach in knee arthroplasty and should be supplemented (if needed) by oral opioids. An additional sciatic nerve blockade is still controversial and should be an individual decision. Large-scale studies are needed to reinforce the promising results of newer regional techniques, such as local infiltration analgesia and adductor canal block.
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The review highlights recent data regarding the safety and efficacy of endovascular treatment of cerebrovascular disease and concerns in anesthesia management. ⋯ Recent data further support the role of endovascular coiling for ruptured aneurysm in broader patient populations. Further studies are needed to investigate the proper management of unruptured arteriovenous malformations, and the key factors in endovascular therapy and anesthesia management associated with stroke outcome.