Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2007
ReviewAnesthesia and sedation outside the operating room: how to prevent risk and maintain good quality.
The purpose of this review is to define risks for anesthesia and sedation outside the operating room, and to suggest how to prevent these risks and maintain quality of care. ⋯ Complications of anesthesia outside the operating room are not well studied, although a few closed claims are appearing in the literature suggesting there is a higher risk. Topics discussed focus on MRI and surgical procedures, principally dental, plastic, and gastrointestinal endoscopy. Risk factors for these procedures are identified and quantified and measures to reduce them discussed, with emphasis on full oxygenation and end-tidal carbon dioxide monitoring. Nonoperating room anesthesia requires skills, experience and organization. Quality can only be assured by ensuring all alternative locations adhere to operating room standards.
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Curr Opin Anaesthesiol · Oct 2007
ReviewIntensive care management of patients with subarachnoid haemorrhage.
The aim of this article is to summarize recent concepts regarding the intensive care management of patients with subarachnoid haemorrhage, emphasizing the detection and treatment of cerebral vasospasm and the management of systemic complications. ⋯ The complex treatment strategies applied after subarachnoid haemorrhage call for interdisciplinary collaboration between neurosurgeons, neuroradiologists, neurointensivists and specialist nurses. Specialized neuromonitoring and neuroimaging techniques must also be available. The neurointensive care unit serves as the focal point for these combined efforts.
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Curr Opin Anaesthesiol · Oct 2007
ReviewHypertonic saline solutions for treatment of intracranial hypertension.
This review aims to provide an update on recent knowledge gained on hypertonic saline solutions for the treatment of intracranial hypertension. Explanatory approaches to the mechanisms underlying the edema-reducing effects of the solutions are outlined, practical aspects of use are presented, and trials that assessed their clinical utility are highlighted. ⋯ Hypertonic saline solutions have evolved as an alternative to mannitol or may be used in otherwise refractory intracranial hypertension to treat raised intracranial pressure. With high osmolar loads, the efficacy of the solution is enhanced, but no simple relationship between the saline concentration and the clinical effects of a solution is established. Caution is advised with high osmolar loads because they carry increased risks for potentially deleterious consequences of hypernatremia or may induce osmotic blood-brain barrier opening with possibly harmful extravasation of the hypertonic solution into the brain tissue.
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Curr Opin Anaesthesiol · Oct 2007
ReviewCurrent psychological approaches to the management of chronic pain.
To provide a review of the rationale and evidence supporting three frequently used psychosocial interventions for chronic pain: cognitive-behavioral therapy, operant behavioral therapy and self-hypnosis training. We also review recent work in these areas, with an emphasis on the 2006 publishing year. ⋯ Cognitive-behavioral therapy and operant behavioral therapy treatments focus on factors that exacerbate or maintain suffering in chronic pain, and should be considered as part of a multidisciplinary treatment paradigm. Self-hypnosis training may also be of benefit, although it appears to be no more (or less) effective than other relaxation strategies that include hypnotic elements.