Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2021
ReviewFrom emergency department to operating room: interventional analgesia techniques for hip fractures.
To provide an update on pain management options with regional anesthesia for patients with hip fractures at the emergency department (ED). ⋯ FICB and FNB are established and recommended techniques in pain management for hip fracture patients. Their use early on in the ED may improve patient comfort and outcome. Pericapsular nerve hip blocks could provide a relevant alternative in future pain management in this group of patients.
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Curr Opin Anaesthesiol · Oct 2021
ReviewNoble gases and neuroprotection: summary of current evidence.
To summarize the current data on neuroprotection derived by noble gas treatment focusing on xenon and argon. ⋯ Promising results are available for neuroprotection derived by noble gas treatment. Results for xenon are more consistent than those for argon. The mechanism of action of xenon (noncompetitive NMDA-receptor inhibition) is also better understood compared with that of argon. The evidence for argon's neuroprotective actions (particularly after TBI) remains uncertain.
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The antidepressant effect of subanesthetic doses of ketamine was recognized 20 years ago. This review briefly summarizes the current understanding of the antidepressant mechanisms and the available clinical research on the use of racemic ketamine and enantiomer esketamine for depression. ⋯ A rapid onset antidepressive effect of ketamine and esketamine has been proven conclusively. The results of extensive basic science research of the mechanism of action of low-dose ketamine doses has led to an alternative hypothesis of the pathophysiology of depression and the development of a novel neurotrophic concept of depression. Further longitudinal studies are warranted to determine the safety and efficacy of repeated administration of ketamine and its analogs to prevent relapse and recurrence of depression.
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Curr Opin Anaesthesiol · Oct 2021
ReviewAnesthesia and intraoperative neurophysiological spinal cord monitoring.
We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery. ⋯ Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.
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Curr Opin Anaesthesiol · Aug 2021
ReviewPatient monitoring in the nonoperating room anesthesia (NORA) setting: current advances in technology.
Nonoperating room anesthesia (NORA) procedures continue to increase in type and complexity as procedural medicine makes technical advances. Patients presenting for NORA procedures are also older and sicker than ever. Commensurate with the requirements of procedural medicine, anesthetic monitoring must meet the American Society of Anesthesiologists standards for basic monitoring. ⋯ NORA procedures constitute a growing percentage of total administered anesthetics. There is no difference in the monitoring standard between that of an anesthetic administered in an operating room and a NORA location. Anesthesiologists in the NORA setting must have the same compendium of monitors available as do their colleagues working in the operating suite.