Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2011
ReviewRevival of old local anesthetics for spinal anesthesia in ambulatory surgery.
In recent years, several older (first intrathecal use in the 1950s, 1960s, and 1970s) local anesthetics have been investigated as spinal anesthetics in ambulatory surgery because these drugs are claimed to cause less transient neurologic symptoms (TNS) than lidocaine which was the main spinal anesthetic for surgery of short-duration for decades. The review covers the current literature. ⋯ The newest results corroborate (at least for chloroprocaine, articaine, and prilocaine) previous data that these drugs provide reliable and mostly well tolerated spinal blocks associated with an apparently smaller risk for postanesthesic TNS as compared with lidocaine. Further studies are warranted regarding broader indications, possible usefulness of adjuvants, and for the exploration of the side-effect profiles in detail. To what extent the observed revival of these older, rather well characterized local anesthetics leads to a wider use of spinal anesthesia in the ambulatory setting remains to be seen. This is also dependent on various organizational and local traditional factors.
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Curr Opin Anaesthesiol · Dec 2011
ReviewRegional anesthetic procedures in immunosuppressed patients: risk of infection.
Due to demographic developments anesthesiologists encounter an increasing number of older and multimorbid patients in their daily routine. Consequently the proportion of immunosuppressed patients (e.g. those with cancer, diabetes mellitus, and those receiving immunosuppressive treatment and/or chemotherapy - e.g. for inflammatory bowel diseases, autoimmune diseases, and after transplantation) will also rise. Regional anesthesia (peripheral nerve blocks and neuraxial blockade) may be beneficial in these patients and will have to be considered in order to provide adequate pain management and minimize risks for the patients. ⋯ So far, there are no guidelines available dealing with indications and limitations of regional anesthetic procedures in these patients. The complication rate is rare but potentially disastrous. However, the technique itself cannot be regarded as absolute contraindication for immunosuppressed patients if precautions are taken. An interdisciplinary approach regarding the indication of regional anesthesia techniques in immunosuppressed patients is recommended. Efforts must therefore be made to achieve an interdisciplinary consensus with relevant risk-benefit considerations.
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Alpha-2-agonists have long been known to have anaesthetic-sparing, sedative and analgesic properties which are desirable in day case anaesthesia. Their routine use was hampered by a high incidence of undesirable effects, however. In recent years, there have been many attempts to define a role for these unique agents in which their benefits would outweigh their apparent disadvantages. ⋯ Alpha-2-agonists still have no clearly defined routine role in day surgery. Their most promising application is in limiting recovery agitation in children, but even here, there remain concerns about their routine use.
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Curr Opin Anaesthesiol · Oct 2011
ReviewFunctional and structural imaging of pain-induced neuroplasticity.
The understanding of the mechanisms underlying chronic pain is of major scientific and clinical interest. This review focuses on neuroimaging studies of pain-induced neuroplastic changes in the human brain and discusses five major categories of pain-induced neuroplastic changes. ⋯ Recent work has substantially broadened our insights into neuroplastic changes that are involved in pain chronification. Future research will focus on the question of whether neuroimaging techniques can be used in the individual chronic pain patient as a biomarker that would allow for an objective diagnosis of different pain conditions and for the prediction of individual responses to specific therapies.
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Curr Opin Anaesthesiol · Oct 2011
ReviewPhantom limb pain and bodily awareness: current concepts and future directions.
Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management. ⋯ Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.