Anesthesiology clinics of North America
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Anesthesiol Clin North America · Mar 2002
ReviewNeuroanesthesia. Innovative techniques and monitoring.
Advances in neuromonitoring have provided insights into neurologic function during anesthesia. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and level of consciousness during anesthesia. The techniques discussed minimize the adverse sequelae of a variety of neurosurgical and orthopedic procedures, reducing the morbidity rates/risks in the perioperative period. ⋯ Accurate and reliable monitoring is essential, and on-going large prospective studies comparing the processed EEG or evoked potential with definable end points in both adult and pediatric populations will be necessary. The use of monitoring, such as the BIS, may improve cost efficiency by reducing the total amount of drug used to maintain anesthesia, as well as enhance recovery. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available.
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Anesthesiol Clin North America · Mar 2002
ReviewNew concepts in acute and extended postoperative pain management in children.
Increased knowledge of the pathophysiology of pain in children and an improved understanding of the pharmacology and pharmacodynamics of multiple agents have provided the clinician with a wide variety of tools to treat postoperative pain in children. The interest in a multimodal approach is kindled by the realization that the combination of a number of therapies can enhance analgesia with fewer untoward side effects. ⋯ Many therapies still require critical evidence-based evaluations to assess how well they work in larger patient populations. Dedication to research, compassionate patient care, and a willingness to teach the next generation of clinicians will bring us closer to the goal of safe and pain-free surgery.
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Fetal surgery is the antenatal treatment of fetal malformations that cannot be adequately corrected after birth. Anesthesia for fetal surgery involves two patients, and issues of maternal safety, avoidance of fetal asphyxia, adequate fetal anesthesia and monitoring, and uterine relaxation are important. Communication with the surgeon to determine the surgical approach and need for uterine relaxation allows the anesthesiologist the ability to vary the anesthetic technique. Lessons learned from fetal surgery may help other neonates with life-threatening anomalies and may help understand the complex issues related to preterm labor.