International anesthesiology clinics
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Int Anesthesiol Clin · Jan 2012
ReviewManagement of bladder volumes when using neuraxial anesthesia.
The major principles of management of bladder function during outpatient neuraxial blockade include choice of short-acting local anesthetics, avoidance of adding epinephrine, and reasonable fluid administration (750 to 1000 mL) to avoid overdistention of the bladder. Data suggest that low-risk patients are at no greater risk of retention than after general anesthesia, and may be discharged home with similar instructions regarding return if unable to void. High-risk patients may require closer monitoring with a BUS, and catheter drainage if volumes exceed 600 mL.
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Int Anesthesiol Clin · Jan 2012
ReviewPediatric acute and surgical pain management: recent advances and future perspectives.
Acute surgical pain management in children is best addressed by a dedicated pain management team. Although PCA with opioids forms the main modality of analgesia, regional techniques have gained popularity. PCA by proxy and PCA basal infusions enhance analgesia but carry a risk for respiratory depression and sedation. ⋯ There are long-lasting effects of pain experienced in early life underscoring the need to treat surgical pain in fetuses, premature infants, and neonates. In contrast, there is a growing body of evidence in animal models implicating opioids in adversely altering neuronal proliferation in the developing brain and clinical studies where in morphine sedation in the neonatal period was found to decrease visual motor integration in childhood, suggesting a potential for neurocognitive sequelae. Ongoing research provides hope that future integration of pharmacogenetics, metabolomics, and proteomics in clinical decision and analgesic selection/dosing processes will maximize analgesia and minimize adverse effects.
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PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice.