Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2012
ReviewProtecting the brain during neurosurgical procedures: strategies that can work.
The quest for neuroprotection strategies during periods of neuronal vulnerability persists despite decades of basic and clinical research. This review will focus on the latest developments in the area of clinical brain protection with the major emphasis on strategies that can be beneficial during neurosurgical procedures. ⋯ The findings of this review suggest that the anaesthesiologist is compelled to use nonpharmacological strategies sometimes based on empiric evidence to protect the brain during neurosurgical procedures. These strategies are simple, have high benefit/risk ratios and are inexpensive. Rigorous controlled clinical studies are needed to investigate the neuroprotective efficacy of these commonly used nonpharmacological methods.
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Cerebrovascular disease is a common cause of death and disability worldwide. The current literature supports an association between blood pressure (BP) and patient outcome during acute stroke. This review will provide an overview of the evidence to guide BP management during acute stroke. ⋯ Both hypertension and hypotension are associated with worse outcomes during acute stroke; however, the optimal hemodynamic parameters are not clearly defined in this patient population. Despite active research, there is a lack of high-quality data guiding current BP management in stroke. Several trials currently underway may clarify the many existing questions on this topic.
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Approximately 100 million people suffer from chronic pain in the USA. Opioid medications are commonly prescribed to treat pain, but are becoming the most widely misused controlled substance nationally. Physicians who treat patients with chronic pain must be cognizant of the federal and state policies that govern the distribution of opioid medications as well as the current standards of medical practice for opioid prescribing. ⋯ The problems of undertreated pain and the epidemic of prescription drug abuse have coincided, creating a need for medical and social policy that protects society and access to appropriate care for those in pain. Federal and state laws are in evolution, and clinicians must remain aware of these changes as well as the issues behind them that will impact safe and appropriate care of patients in pain.
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This review highlights recent advances in epilepsy surgery specifically awake surgery technique, and introduces the clinical application of neuromodulation concept in this field. ⋯ Although the final goal of epilepsy surgery is the same in most cases, -that is, maximizing normal neurological function while minimizing adverse effects, the clinical approach differs for each patient. Therefore, advancement of a new approach to identify the epileptogenic areas and new surgical treatment option would be greatly beneficial for patients with intractable epilepsy.
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Curr Opin Anaesthesiol · Oct 2012
ReviewPrehospital management of severe traumatic brain injury: concepts and ongoing controversies.
Prehospital management affects long-term outcome of patients with severe traumatic brain injury (TBI). This article reviews the current concepts and ongoing controversies of prehospital treatment of severe TBI. ⋯ Prehospital management of TBI remains challenging. There are no universal objectives suitable to all patients. Randomized, controlled clinical trials are necessary for developing optimal protocols for paramedic and physician emergency medical teams.