Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2010
ReviewIs nitrous oxide use appropriate in neurosurgical and neurologically at-risk patients?
To address controversial issues surrounding the use of nitrous oxide as a component of anesthesia in neurosurgical and neurologically at-risk patients. ⋯ Except in a few specific circumstances, there exists no conclusive evidence to support the dogmatic avoidance of nitrous oxide in neurosurgical patients.
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Endoscopic neurosurgical procedures are becoming more frequent and popular in the treatment of intracranial disease. When endoscopy involves the intraventricular structures, irrigating solutions are required and may contribute to sudden and sharp increases in intracranial pressure. More recently, nasal endoscopic approach has been used to perform skull base surgery for aneurysms and tumours. We have analysed published articles in order to detect anaesthesia management and perioperative complications. ⋯ Invasive arterial blood pressure and intracranial pressure should be measured continuously during neuroendoscopies to detect early intraoperative cerebral ischaemia instead of waiting for the appearance of bradycardia which may be a late sign. General anaesthesia remains the technique of choice. Intracranial haemorrhage increases the likelihood of perioperative complications. Close postoperative monitoring is required to diagnose and treat complications such as convulsions, persistent hydrocephalus, haemorrhage or electrolytic imbalance.
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Curr Opin Anaesthesiol · Aug 2010
ReviewAnesthesia in prehospital emergencies and in the emergency department.
Recently, notable progress has been made in the field of anesthesia drugs and airway management. ⋯ Preoxygenation should be performed with high-flow oxygen delivered through a tight-fitting face mask with a reservoir. Ketamine may be the induction agent of choice in hemodynamically unstable patients. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. Experienced healthcare providers may consider prehospital anesthesia induction. Moderately experienced healthcare providers should optimize oxygenation, hasten hospital transfer and only try to intubate a patient whose life is threatened. When intubation fails twice, ventilation should be performed with an alternative supraglottic airway or a bag-valve-mask device. Lesser experienced healthcare providers should completely refrain from intubation, optimize oxygenation, hasten hospital transfer and ventilate patients only in life-threatening circumstances with a supraglottic airway or a bag-valve-mask device. Senior help should be sought early. In a 'cannot ventilate-cannot intubate' situation, a supraglottic airway should be employed and, if ventilation is still unsuccessful, a surgical airway should be performed. Capnography should be used in every ventilated patient. Clinical practice is essential to retain anesthesia and airway management skills.