Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2012
ReviewVertebroplasty and kyphoplasty: new evidence adds heat to the debate.
Cement bone augmentation has become very popular worldwide in treating painful noncomplicated spine fractures. Controversy about the effectiveness was raised by two randomized trials in 2009. Recent new evidence contradicts those findings giving credit to vertebroplasty/kyphoplasty. ⋯ The saga is unfinished. The treatment of vertebral compression fractures with cement augmentation is still in its infancy. The potential for development with new materials and the injection of biologic and active bone cements or anticancer products, in metastatic disease, will revolutionize the treatment of this condition.
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Intrathecal drug delivery (IDD) continues to gain relevance as a beneficial tool for the treatment of cancer pain, spasticity, and chronic nonmalignant pain. This review includes advances in recommendations for the use of IDD for cancer pain, nonmalignant pain, and spasticity, as well as a new study of cerebrospinal fluid kinetics, updates in logistics, and recent reports of complications. ⋯ IDDS continues to play an important role in the management of severe intractable pain. However, the most important areas in need of advancement, outcome studies and new therapeutics, did not have any significant breakthroughs over the past year. There is some interesting preclinical work on new therapeutics but likely the translation into clinical practice will be challenging. More work is also needed on improving technologies that will result in less catheter breaks and disconnects.
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Curr Opin Anaesthesiol · Oct 2012
ReviewFluid resuscitation in patients with traumatic brain injury: what is a SAFE approach?
In patients with traumatic brain injury (TBI), dysfunction of the neurovascular unit ('blood-brain barrier') is a common finding, resulting in maldistribution of water and osmoles within the brain. The purpose of the present article is to review the underlying physiology of osmolality and fluid therapy in TBI. ⋯ In the context of the published literature on this topic, it appears that the osmolality of an infusion solution rather than the colloid osmotic pressure per se represents the key determinant in the pathogenesis of cerebral edema formation.
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Curr Opin Anaesthesiol · Oct 2012
ReviewFunctional outcome after major orthopedic surgery: the role of regional anesthesia redefined.
Regional anesthesia can provide optimal pain management and stress reduction. This article aims to establish the impact of regional anesthesia in facilitating the recovery process, measured by significant clinical outcomes. ⋯ In order to establish the role of regional anesthesia in functional outcome after major orthopedic surgery, assessment of pain control is no longer sufficient. New clinically relevant outcomes must be introduced and used for procedure-specific studies.