Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewThe role of tetrastarches for volume replacement in the perioperative setting.
Current opinion in perioperative fluid therapy suggests that the use of colloids to achieve haemodynamic optimization may result in improved clinical outcomes. This has focused interest on the colloid solutions, particularly on the newest of these, the tetrastarches. This review will address the advantages and disadvantages of the starch solutions with particular emphasis on the advantages offered by the tetrastarches, as these products, which have been widely used in Europe for a number of years, have recently been released in the United States. ⋯ Tetrastarch represents a substantial advance in colloid therapy, offering good volume effectiveness with a very low risk of adverse effects.
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Clinical and experimental data suggest that hypergylcaemia lowers the ischaemic neuronal threshold and worsens outcome in the presence of neurological injury from trauma, stroke and subarachnoid haemorrhage. This review aims to appraise the evidence for tight glycaemic control in patients with neurological injury. ⋯ Clinical and experimental data suggest that hyperglycaemia lowers the ischaemic neuronal threshold in the presence of neurological injury. Tight glycaemic control may result in hypoglycaemia, which in itself can be detrimental. Therefore, it seems sensible that we should accept slightly less tight blood glucose control than in the critically ill patient without neurological injury.
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Curr Opin Anaesthesiol · Oct 2008
ReviewThe toxicity of local anesthetics: the place of ropivacaine and levobupivacaine.
Ropivacaine and levobupivacaine were developed after evidence of bupivacaine-related severe toxicity. Despite a comparable analgesic profile, quantitative differences become evident with regard to their specific rate of systemic toxicity. The present article provides a concise review of the toxic potencies of levobupivacaine and ropivacaine. ⋯ Compared with bupivacaine, both agents may be considered as 'more well tolerated' but not as 'totally well tolerated', as they are still capable of inducing systemic and local toxicity. However, ropivacaine seems to have the greatest margin of safety of all long-acting local anesthetics at present.
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Central neuropathic pain is an important and disabling but often neglected problem following central nervous system lesions. The present review highlights recent advances in the understanding of the underlying mechanisms and in the diagnosis and treatment of central pain. ⋯ Increased insight into the mechanisms of central pain will hopefully lead to increased efforts to study mechanism-based treatment of central pain.
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Evidence from retrospective studies suggests that regional anesthesia reduces the risks of major complications associated with carotid endarterectomy compared with general anesthesia, namely: stroke, stroke/death, death and myocardial infarction. ⋯ The anesthesiologist should learn how to place a superficial cervical plexus block. The technique is easy to master, effective and carries a low risk of inducing a serious complication.