Current opinion in anaesthesiology
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The aim of this article is to review current practice of spinal anesthesia regarding technique and medication use; review recent applications of spinal anesthesia to subspecialty care in outpatient, cardiac, and obstetrical anesthesia; and update risk assessment associated with spinal anesthesia. ⋯ Innovations in technology, equipment, and needle design improved safety and decreased complication rates from spinal anesthesia. The increased popularity of ambulatory surgical procedures has resulted in more frequent use of spinal anesthesia. Intrathecal narcotic analgesia is used increasingly in fast-tracking cardiac surgical protocols. Modern anesthetic and analgesic techniques include resurgence of older agents (2-chloroprocaine) as well as new agents (levobupivacaine and ropivacaine) that are used in conjunction with adjuvant intrathecal medications (opioids, vasopressors, and alpha-2 adrenergic agonists). Surgical thromboprophylaxis and the increased use of anticoagulants in patients with cardiovascular disease have challenged anesthesiologists to update clinical guidelines to minimize the risk of hemorrhagic complications such as epidural hematoma. The risk/benefit ratio of spinal anesthesia should be individualized. The continued popularity of spinal anesthesia is due to the safety, effectiveness and efficiency of this technique.
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This review highlights recent data regarding factors associated with brain arteriovenous malformation hemorrhage and different treatment options. ⋯ The recent identification of clinical and genetic factors associated with brain arteriovenous malformation hemorrhage, as well as studies on treatment outcomes, will help risk stratification in management choices. Future studies are needed to identify arteriovenous malformation patients at the greatest risk of spontaneous hemorrhage and to develop specific medical therapies.
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This review was performed through a Medline research to evaluate articles published between January 2004 and April 2005. Technical procedures, indications, drugs, infusion regimens, and complications of continuous peripheral nerve blocks were considered. ⋯ Continuous peripheral nerve blockade is an effective and safe technique for postoperative analgesia, even when administered at home. To optimize this technique, further studies are needed to help minimize the risk of side effects, improve techniques to locate the targeted nerve (stimulating catheters or ultrasound imaging) and choose less toxic drugs (levobupivacaine and ropivacaine) with more effective infusion regimens.
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In past years, important advances have been made in the treatment of idiopathic headache disorders. New controlled trials have been published for the acute and the prophylactic drug and non-drug therapies. Furthermore, new headache entities have been described by the International Headache Society for which treatment recommendations can be given. ⋯ Recent advances in headache treatment comprise growing evidence for an appropriate drug administration and for differential drug therapy rather than the development of new drugs or procedures. Surgical and other non-drug treatment procedures are under discussion and might be an additional tool for headache treatment in future years.
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Curr Opin Anaesthesiol · Oct 2005
Postoperative pain, nausea and vomiting in neurosurgical patients.
Postoperative pain and postoperative nausea and vomiting are significant problems for neurosurgical patients and their carers. The treatment of these problems is widely perceived to be inadequate, however, especially in patients undergoing craniotomy, and there are few large, randomized controlled trials. The main issue has been fear of side effects, especially those masking neurological signs. A review of the recent literature therefore is justified. ⋯ There is still a lot of scope to research and refine pain and postoperative nausea and vomiting management in cranial and spinal neurosurgical patients. Large-scale studies are required to define the current state of practice, determine effective treatments and define the incidence of side-effects.