Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2006
ReviewPerioperative management of chronic pain patients with opioid dependency.
In this article, we discuss the perioperative anesthesia and pain management of patients with chronic pain receiving chronic opioid administration. In our practice we may expect to be confronted with opioid-dependent patients in routine anesthesia practice and should acquire specific knowledge and skills to effectively manage the perioperative and acute pain management issues that arise. ⋯ In our clinical practice, we should employ multimodal pain management therapy by using an around-the-clock regimen of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, acetaminophen, and regional blockade. Dosing regimens should be individualized to optimize efficacy while minimizing the risk of adverse events.
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Curr Opin Anaesthesiol · Jun 2006
ReviewImaging techniques for regional nerve blockade and vascular cannulation in children.
Many regional anaesthesia techniques as well as central venous access in paediatric patients are still described insufficiently. This review article describes the basics in small part ultrasonography and highlights new developments in ultrasonographic-guided regional anaesthetic techniques and vascular access. ⋯ Regional anaesthesia and vascular access under ultrasonographic guidance offers significant advantages and improved safety. Additional education and hand skills, extensive experience and adequate equipment are necessary for the effective implementation of these methods in the daily clinical practice.
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Curr Opin Anaesthesiol · Jun 2006
ReviewThe use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics.
Neuraxial adjuvant drugs are used to improve analgesia and to decrease complications associated with a high dose of a single drug. Opioids are used in routinely, but alpha2-agonists, such as clonidine or cholinesterase inhibitors (neostigmine), have also been used for labour analgesia or to relieve pain following caesarean section. Both drugs possess a common mechanism of action that can be beneficial. ⋯ Co-administration of neuraxial drugs may enhance analgesia and reduce the side effects of each drug. Clonidine and neostigmine may be used in obstetrics, under some conditions.
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Curr Opin Anaesthesiol · Jun 2006
ReviewRecent developments in the perioperative fluid management for the paediatric patient.
Maintenance fluid therapy represents the volume of fluids and amount of electrolytes and glucose needed to replace anticipated physiological losses from breath, sweat and urine and to prevent hypoglycaemia. For 50 years, this therapy was based on Holliday and Segar's formula, which proposed to match children's water and electrolyte requirements on a weight-based calculation using hypotonic solutions. Recent publications highlight the risk of hyponatraemia in the postoperative period and the facilitating role of a hypotonic infusion, leading some people to recommend replacing hypotonic with isotonic solutions. ⋯ As free water excretion is altered for all children in the postoperative period, it is necessary to reduce the volume of maintenance fluid therapy to half the previously recommended volume. The choice of an isotonic solution should be more pertinent to that of a hypotonic solution, but evidence is lacking for a definitive answer.
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Historically, ephedrine has been recommended as the best vasopressor in obstetrics because animal studies showed it caused less reduction in uterine blood flow compared with alpha-agonists. Recent clinical evidence, however, suggests that this is not as important as initially thought. This review evaluates current data with a focus on spinal anesthesia for cesarean section. ⋯ When current evidence is considered, in the authors' opinion, phenylephrine is the vasopressor that most closely meets the criteria for the best vasopressor in obstetrics.