Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2010
ReviewOpioid antagonists for prevention and treatment of opioid-induced gastrointestinal effects.
The therapeutic action of opioid analgesics is compromised by peripheral adverse effects, among which constipation is the most disabling as laxatives often fail to provide satisfactory relief. This review highlights recent advances in the specific control of opioid-induced constipation by opioid receptor antagonists with limited systemic bioavailability or a peripherally restricted site of action. ⋯ The availability of opioid receptor antagonists with restricted access to the central nervous system provides a novel opportunity to specifically control opioid-induced constipation and other peripheral adverse effects of opioid analgesics. Further studies are needed to evaluate the long-term efficacy, safety and cost-effectiveness of this approach.
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Curr Opin Anaesthesiol · Oct 2010
ReviewNoninvasive cerebral oximetry: is there light at the end of the tunnel?
There is increasing interest in the application of near infrared spectroscopy (NIRS) as a noninvasive monitor of cerebral oxygenation. This review will briefly describe the principles of NIRS and examine current evidence for its clinical application as a monitor of the adequacy of cerebral oxygenation in adults. ⋯ NIRS offers noninvasive monitoring of cerebral oxygenation over multiple regions of interest in a wide range of clinical scenarios. It has many potential advantages over other neuromonitoring techniques, but further technological advances are necessary before it can be introduced more widely into clinical practice.
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Curr Opin Anaesthesiol · Oct 2010
Review Case ReportsNondermatomal somatosensory deficits: overview of unexplainable negative sensory phenomena in chronic pain patients.
To review the literature and our current understanding of nondermatomal somatosensory deficits (NDSDs) associated with chronic pain in regards to their prevalence, assessment and clinical presentation, cause and pathophysiology, relationship with conversion disorder and psychological factors, as well as their treatment and prognosis. ⋯ NDSDs represent prevalent phenomena associated with chronic pain. Further, research is needed to elucidate their origin, response to treatment, and prevalence in the general population, primary care settings, and nonpain patients.
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Curr Opin Anaesthesiol · Oct 2010
ReviewThe clinical (ir)relevance of opioid-induced immune suppression.
Opioid-induced immune suppression has been demonstrated in cell culture experiments and in animal models. This review examines whether opioids also increase the risk of infections in the perioperative setting or on the ICU. ⋯ In contrast to in-vitro studies and to animal models, conclusive evidence is currently lacking that opioids induce clinically relevant infectious complications in patients. However, these findings should be interpreted with great caution, as almost no adequately designed trials have been performed. Peripherally selective opioid receptor antagonists might be useful if opioid-induced immune suppression should prove to be clinically relevant.
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Curr Opin Anaesthesiol · Oct 2010
ReviewFrom basic concepts to emerging technologies in regional anesthesia.
The present article details how our understanding of the basic concepts of regional anesthesia has recently evolved. We will appraise current technological advances and question the commensurate nature of the relationship between tradition and innovation. ⋯ Over the past decade, our understanding of the fundamental concepts of regional anesthesia continues to be challenged by emerging experimental and clinical evidence.