Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Aug 2013
ReviewConsciousness and responsiveness: lessons from anaesthesia and the vegetative state.
The aim of this article is to review recent behavioural and neuroimaging studies in anaesthesia and the vegetative state. ⋯ We discuss future avenues of research in the field, in order to improve the detection of awareness during anaesthesia and the vegetative state using neuroimaging and neurophysiologic techniques.
-
To review the neurophysiology and neuroanatomy of normal aging and the recent recommendations for the clinical management of general anesthesia and sedation in the elderly. ⋯ Our analysis suggests that understanding the neurophysiology and neuroanatomy should be part of the standard working knowledge of anesthesiologists and that this knowledge can guide their use of the electroencephalogram to track more accurately the brain states of elderly patients receiving anesthesia care.
-
Diabetes mellitus and its related comorbidities present a growing challenge in perioperative medicine. And also largely independent from a history of diabetes, dysregulations of glucose homeostasis occur as part of the body's stress response. Dysregulations of glucose homeostasis, acute or chronic, are closely correlated with impaired prognosis in perioperative medicine. Treatment strategies remain somewhat controversial, as both the affliction and its correction have a blind side. ⋯ Literature clearly shows that leaving glycemic control out of focus is dangerous for the patient; efforts to control glycemia to a moderate target improve the patient's outcome.
-
Curr Opin Anaesthesiol · Aug 2013
ReviewAnaesthetic considerations for endoscopic retrograde cholangio-pancreatography procedures.
The purpose of this review is to evaluate the current literature on the use of general anaesthesia and propofol deep sedation for patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Propofol is primarily an anaesthetic agent, but its use in a sedative capacity has resulted in the extensive off-label administration of this drug by gastroenterologists and other nonanaesthesia personnel. This has created controversy and enabled the gastroenterology community to gather evidence and campaign for US Food and Drug Administration approval to administer propofol to patients undergoing ERCP and other endoscopic procedures. ⋯ Deep sedation with propofol, administered by anaesthesia personnel, can be used as an alternative to general anaesthesia for a select group of patients undergoing ERCP procedures. Further research is necessary to clarify the nature and parameters of deep sedation.
-
Curr Opin Anaesthesiol · Aug 2013
ReviewRegional anesthesia for trauma outside the operating theatre.
Pain management in the trauma patient can be challenging, especially outside the operating room setting. Traditional analgesics such as opioids and NSAIDs are also problematic in trauma care. In this review, the use of regional anesthetic techniques outside the operating theatre is discussed. ⋯ Pain is often poorly managed in the trauma patient. In addition to quality analgesia, regional anesthesia provides a variety of benefits in the trauma setting outside the traditional operating room setting. While further utilization requires increased training and structural changes, existing tools such as ultrasound are removing barriers to the widespread use of peripheral nerve block techniques across multiple disciplines.