Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2011
ReviewUltrasonography of the lumbar spine for neuraxial and lumbar plexus blocks.
Ultrasonography of the spine has evolved into a well described technique that can be applied to facilitate neuraxial and lumbar plexus blockade. ⋯ Preprocedural ultrasound imaging of the spine may reduce the technical difficulty of neuraxial blockade and also improve clinical efficacy. Similar benefits are expected in the setting of lumbar plexus blockade although there is currently no evidence to confirm this. Real-time ultrasound-guided neuraxial and lumbar plexus blockade are challenging techniques that need further validation.
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Curr Opin Anaesthesiol · Oct 2011
ReviewChanging trends in monitoring brain ischemia: from intracranial pressure to cerebral oximetry.
Cerebral ischemia forms the pathophysiological basis of several acute neurological conditions. Successful management of these conditions depends on early and accurate identification of ischemia and prompt treatment. Several techniques of assessing ischemia have evolved over decades. But their importance in the management of neurological patients remains ambiguous. ⋯ A wide range of options are available for monitoring adequacy of regional and global CBF. But no single monitor per se fulfils the requirements of all clinical situations. Impact of these monitors on clinical outcomes is equivocal. Also, at present, many of these monitors are invasive and not cost-effective.
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Curr Opin Anaesthesiol · Oct 2011
ReviewAnesthetic concerns for pediatric patients in an intraoperative MRI suite.
Intraoperative magnetic resonance imaging (iMRI) is an evolving technology used to provide precise intraoperative navigation during a variety of neurosurgical and other types of surgical procedures. Anesthesiologists need to be aware of the unique challenges created by this environment. Failure to recognize the differences between the diagnostic MRI environment and the iMRI environment can compromise the safety of the patient and operating room staff and present logistical problems. ⋯ We describe the design of different iMRI suites as well as provide a breakdown of both patient and equipment issues encountered by anesthesiologists practicing in this environment. Finally, we offer our ongoing experience in this environment and provide suggestions to optimize patient outcomes.
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The present review is intended to give an overview of fibromyalgia for the anesthesiologist. While the basics of the treatment of fibromyalgia are included, the intent is to provide context to discuss the potential implications in perioperative management. ⋯ The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed.