Current opinion in anaesthesiology
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Worldwide, the number of overweight and obese patients has increased dramatically. As a result, anesthesiologists routinely encounter obese patients daily in their clinical practice. The use of regional anesthesia is becoming increasingly popular for these patients. When appropriate, a regional anesthetic offers advantages and should be considered in the anesthetic management plan of obese patients. The following is a review of regional anesthesia in obesity, with special consideration of the unique challenges presented to the anesthesiologist by the obese patient. ⋯ Successful peripheral and neuraxial blockade in obese patients requires an anesthesiologist experienced in regional techniques, and one with the knowledge of the physiologic and pharmacologic differences that are unique to the obese patient.
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Curr Opin Anaesthesiol · Oct 2009
ReviewRole of N-methyl-D-aspartate receptor antagonists in postoperative pain management.
In recent years, hundreds of studies have examined the clinical efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and dextromethorphan as an adjunct to routine postoperative pain management. The purpose of this review is to describe the detail of the study that successfully demonstrated the efficacy of NMDA receptor antagonists. ⋯ The co-administration of ketamine and morphine as a mixture is not recommended for postoperative pain relief. As an adjunct in multimodal analgesia, low-dose ketamine infusion and the administration of dextromethorphan may be able to improve postoperative pain status. Memantine exhibits the greatest potency among NMDA receptor antagonists. In future, research should consider the perioperative infusion of ketamine followed by long-term administration of memantine for the prevention of persistent pain.
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Curr Opin Anaesthesiol · Oct 2009
ReviewParavertebral block: cervical, thoracic, lumbar, and sacral.
This article outlines the new developments around all four types of paravertebral block: cervical, thoracic, lumbar, and sacral. ⋯ We discuss commonality and differences between the four types of paravertebral blocks, and newer indications and concerns, especially pertaining to nerve microanatomical differences, are highlighted.
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Curr Opin Anaesthesiol · Oct 2009
ReviewAcute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes.
Patients with fibromyalgia are at increased risk to experience increased and prolonged postoperative pain. In this review, we will provide an overview of pathophysiological characteristics of fibromyalgia relevant for enhanced pain processing after surgery. Furthermore, we will present some potential treatment options in the perioperative period based on specific symptoms of individual fibromyalgia patients to optimize their pain management after surgery. ⋯ The perioperative pain management of patients with fibromyalgia is challenging and should include symptom-based approaches to target enhanced central sensitization and decreased inhibition in these patients as well as their psychological syndromes aiming to decrease acute and prolonged pain after surgery.
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Curr Opin Anaesthesiol · Oct 2009
ReviewLipid resuscitation for local anesthetic toxicity: is it really lifesaving?
Laboratory studies and clinical reports have led to the acceptance of lipid emulsion as an effective treatment of local anesthetic-induced cardiac arrest. This review discusses subsequent clinical reports, relevant laboratory studies and topics for further research. ⋯ Lipid emulsion infusion appears to be an effective treatment for cardiac toxicity induced by lipophilic medications. Given the difficulties of performing clinical trials, further laboratory investigation and clinical correlation are needed to better define its role in resuscitation.