Current opinion in anaesthesiology
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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
ReviewAneurysmal subarachnoid hemorrhage: an update on the medical complications and treatments strategies seen in these patients.
Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with high mortality and poor outcome among survivors. Early surgical or endovascular securing of the aneurysm is the norm, and management of these patients is precarious due to their unstable intracranial physiology and the severe systemic medical complications common in SAH. ⋯ Growing knowledge of the physiologic derangements associated with poor outcomes in SAH can improve our understanding of the widespread physiologic changes occurring with SAH and with further research, may provide clinicians with a direction for increasingly meaningful intervention. Ongoing investigation of our current therapeutics enable clinicians to apply them more judiciously to suitable patients, thereby enhancing the benefit and minimizing the complications of such treatments. Furthermore, by re-evaluating previously disproved treatments through the use of novel regimens or administration routes, promising treatment options are emerging.
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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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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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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.