Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2012
ReviewWound/intra-articular infiltration or peripheral nerve blocks for orthopedic joint surgery: efficacy and safety issues.
Pain following arthroplasty is managed utilizing continuous peripheral nerve blocks (PNB) or local infiltration analgesia (LIA). The current economic climate in many countries requires discharge from the hospital within a couple of days following arthroplasty. Earlier studies had documented the efficacy of LIA for lower limb arthroplasty with preserved motor function and early rehabilitation, but some recent studies fail to confirm such a benefit. The motor block associated with PNB can be challenging with well tolerated rehabilitation. This review will discuss the efficacy and safety of these two analgesic techniques. ⋯ More rigorously conducted large-scale comparative studies are required to document the relative safety and efficacy of these two analgesic techniques. Standardization of infiltration techniques, catheter location, drugs and dosing are much needed. LIA with extended duration long-acting local anesthetic is in its infancy and may be an alternative to PNBs.
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Can a general anesthetic binding to its membrane receptors alter global brain activity to cause loss of consciousness? ⋯ An important feature of general anesthesia is a preferential inhibition of global feedback connectivity when general anesthetics bind to allosteric sites of gamma-aminobutyric acid receptors present in the cerebral cortex.
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Curr Opin Anaesthesiol · Aug 2012
ReviewRegional anesthesia outside the operating room: indications and techniques.
Regional anesthesia is not only performed in the operating room. There are indications for the use of these techniques for pain relief in the emergency department and for anesthesia support of procedures outside the operating room. In this review, we will provide an overview of the indications for the regional techniques performed in the out-of-operating room environment. ⋯ Regional anesthesia is a valuable option for analgesia in trauma patients, enabling improved pain control in the emergency department and has benefits in the anesthetic management of therapeutic procedures outside the operating room. For many blocks, ultrasound guidance is useful.
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Curr Opin Anaesthesiol · Aug 2012
ReviewAirway management outside the operating room: hazardous and incompletely studied.
The review examines recent knowledge regarding techniques and complications of airway management in hospitals, outside the operating room. The review does not consider airway management at the time of cardiopulmonary resuscitation as this is a separate topic. ⋯ The notably high rate of failure of primary intubation attempts and high complication rates of airway procedures create a strong argument for increased research focus in this area of high-risk and incomplete knowledge.