Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewMultimodality monitoring of the central nervous system using motor-evoked potentials.
This review was conducted to examine the role of motor-evoked potential monitoring in spine and central nervous system surgery to determine whether other monitoring modalities such as the wake-up test or somatosensory-evoked potentials can be eliminated. ⋯ The literature supports the use of multimodality monitoring using all of the electrophysiological techniques that can provide intraoperative information about the neural structures at risk during the surgery.
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Clinical research has identified blood transfusion as an independent risk factor for immediate and long-term adverse outcomes, including an increased risk of death, myocardial infarction, stroke, renal failure, infection and malignancy. New findings have called into question the traditional assumptions clinicians utilize in evaluating the risks and benefits of blood transfusion. Appreciation of newly recognized risks is important for conserving scarce resources and optimizing patient outcomes. ⋯ The benefits of blood transfusion have never been conclusively demonstrated, but evidence of transfusion-related harm continues to accumulate. Given the transfusion triggers that currently predominate in clinical practice it appears that clinical outcomes could improve significantly with more widespread adoption of restrictive transfusion strategies.
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Acute neuropathic pain (ANP) is a condition that is under-recognized, often difficult to treat and one that may progress to persistent pain and disability. This review examines the diagnosis and treatment in order to assist clinicians in providing better care to patients with this debilitating pain. ⋯ The diagnosis of ANP is assisted by knowledge of the medical circumstances that have a higher risk of the condition developing, a detailed pain history with a directed examination and use of neuropathic pain scales. Although the data are lacking, agents that have demonstrated efficacy in persistent neuropathic pain states should be used in ANP. Refractory ANP could be treated with either intravenous lidocaine or calcitonin. Future research should be directed at validating a scale of neuropathic pain in ANP and conducting more therapeutic trials.