Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2011
ReviewInfluence of anesthesia on cerebral blood flow, cerebral metabolic rate, and brain functional connectivity.
To describe recent studies exploring brain function under the influence of hypnotic anesthetic agents, and their implications on the understanding of consciousness physiology and anesthesia-induced alteration of consciousness. ⋯ Accumulating evidence suggests that hypnotic anesthetic agents disrupt large-scale cerebral connectivity. This would result in an inability of the brain to generate and integrate information, while external sensory information is still processed at a lower order of complexity.
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Deep brain stimulation (DBS) is a well accepted treatment modality for many movement disorders such as Parkinson's disease and an increasing number of other functional neurological disorders like dystonias and epilepsy. This review will highlight the recent developments in our knowledge regarding the effects of anesthetic agents on neurophysiologic recording and anesthetic management of patients undergoing the insertion of a DBS. ⋯ There will continue to be an increase in the use of DBS for many neurological and functional disorders, especially in the aging baby boomer population. Anesthetic technique will vary depending on the prevalent practice in individual institutions and requirements of the specific surgical procedure.
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The persistence of pain after surgical procedure or trauma has become a major focus of interest and its prevention now represents a challenge as an indicator of quality of healthcare. The only way to develop effective strategies to prevent the development of chronic pain is to better understand the mechanisms involved in the progression from acute to chronic pain, with the aim to target high-risk patients and to adapt perioperative management. ⋯ A dynamic view of both physiological and psychological response of an individual after injury (trauma, surgery) should improve our ability to target predisposed patients who might develop persistent pain. We should then be more able to provide those patients with the most appropriate preventive management.
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Curr Opin Anaesthesiol · Oct 2011
ReviewPlacebo analgesia and beyond: a melting pot of concepts and ideas for neuroscience.
In the last two decades, some of the neuroanatomical and neurophysiological substrates of the placebo effect have been elucidated. What has emerged is the multifactorial nature of the placebo effect, such that there is not a single placebo effect but many. Here we report on recent advances in our understanding of this phenomenon, with particular emphasis on its use as an experimental model to better clarify different brain mechanisms. ⋯ The study of the placebo effect is paying dividends and bodes well for the future. Whereas in clinical practice it can increase the efficacy of a therapy, in the experimental setting it represents an excellent tool for neuroscience.
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Regional anesthesia is evolving rapidly and increasing in popularity as evidenced by the large number of publications on the topic. In this healthcare environment, continual assessment of the safety and efficacy of clinical practice is critical. Neurologic complications of regional anesthesia can result in disability and are feared by patients and clinicians. Ultrasound guidance is unique as a nerve localizing technique in terms of being able to image needle-nerve proximity and potentially prevent direct trauma to nerves. This article reviews the recent literature relevant to neurologic complications of regional anesthesia. ⋯ The pathogenesis of perioperative nerve injury is complex with multiple potential etiologies and mechanisms. The role of intraneural injections as a modifiable risk factor for neurologic complications due to regional anesthesia remains topical. Relevant publications include studies on the morphology of peripheral nerves and risk of perioperative nerve injury in the context of both neuraxial anesthesia and PNB.