Current opinion in anaesthesiology
-
Anaesthetists who manage acute and chronic pain need to be familiar with current research and practice guidelines in these areas. New local anaesthetics and new routes of administration for opioids and adjuvants may further improve our management of acute pain. ⋯ The limitations of nerve blocks are acknowledged and guidelines for managing chronic pain and opioids are available. Anaesthetists must recognize psychological difficulties as a significant perpetuating factor in chronic pain.
-
Despite its efficacy, bupivacaine has never been considered to be the most suitable agent for achieving anaesthesia and analgesia in the obstetric patient. Ropivacaine is less cardiotoxic than bupivacaine and, at low concentrations, can produce analgesia with minimal motor block, attributes which make it potentially very suitable for use in obstetrics. However, further research is required to ultimately establish ropivacaine's place in obstetric anaesthesia and analgesia. Levobupivacaine, the L isomer of bupivacaine, is of similar potency to bupivacaine but has the advantage of being significantly less cardiotoxic than racemic bupivacaine, which suggests that it might ultimately replace racemic bupivacaine in obstetric practice.
-
Curr Opin Anaesthesiol · Apr 1998
Fluid replacement for hypotensive injury victims: how, when and what risks?
Intravenous fluid administration is considered universally indicated for patients with post-traumatic hypotension of presumed hemorrhagic origin, regardless of the mechanism of injury, anatomic location, and whether hemostasis has been achieved. This premise is based primarily on animal studies in which blood loss results from a controlled catheter withdrawal. However, more recent hemorrhage models that incorporate a vascular injury, as well as recently completed clinical trials, have indicated that attempts to restore blood pressure before surgical hemostasis may have the undesirable effects of accentuating hemorrhage and mortality.