Anesthesiology clinics of North America
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Anesthesiol Clin North America · Dec 2003
Case ReportsSacral neuromodulation for chronic pain conditions.
Some of the pelvic pain syndromes seem to have features of neurogenic inflammation and neuropathic pain in common. As opposed to being separate disease entities, they may represent a spectrum of clinical presentations of CRPS I of the pelvis. ⋯ The techniques of retrograde root stimulation may offer superior results with fewer complications and lead migrations when compared with other methods. Perhaps neuromodulation should be used earlier in the treatment paradigm for these disorders, before the potentially injurious procedures of hydrodistention, bladder installations, and cystectomies.
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Anesthesiol Clin North America · Dec 2003
A simple approach to outcomes assessment of the therapeutic and cost-benefit success rates for spinal cord stimulation therapy.
SCS was found to be cost-effective and therapeutically effective in this study for a majority of patients who had successful trial screening and were determined to be suitable candidates for SCS therapy. This is consistent with prior research if not slightly more encouraging, because typically half of the patients implanted with SCS reported 50% or more pain relief. Strikingly, most patients were considered cost successes. Overall, this study provides continued support that spinal cord stimulation offers the medical community an effective treatment for pain and reduces costs associated with the treatment of chronic intractable pain patients.
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Anesthesiol Clin North America · Sep 2003
Review Comparative StudyOff-pump coronary surgery: how do the anesthetic considerations differ?
In recent years, there has been much interest in performing coronary artery bypass graft (CABG) surgery without the aid of cardiopulmonary bypass (CPB). Initial efforts focused on "minimally invasive" direct coronary artery bypass, wherein the left anterior descending artery is bypassed with an in situ left internal mammary artery graft through a small left anterior thoracotomy. A more widely adopted approach however, is off-pump CABG (OPCAB), in which CABG surgery is performed on one or more vessels through the usual median sternotomy approach without the aid of CPB. This article reviews the differences in the anesthetic considerations of OPCAB compared to conventional CABG using CPB.
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Anesthesiol Clin North America · Sep 2003
ReviewWhat does transesophageal echocardiography add to valvular heart surgery?
No single monitoring tool in the last decade has had more of an effect on intraoperative decision making and surgical management of cardiac valvular pathologies than has TEE. It has become the standard of care for evaluating reparative valvular procedures, thus providing an immediate gauge of the surgical results and helping to avoid suboptimal surgical outcomes. As the technology of TEE and its application advance, so too should the ability to diagnose and manage valvular pathologies, broaden the range of surgical options, and ultimately improve patient outcomes.
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Anesthesiol Clin North America · Sep 2003
ReviewThe systemic inflammatory response to cardiopulmonary bypass.
Although our understanding of the basic pathophysiology of systemic inflammatory response to CPB has significantly advanced in the last 2 decades, these experimentally derived ideas have yet to be fully integrated into clinical practice. Treatment of the systemic inflammatory response to CPB is also confounded by the fact that inhibition of inflammation might disrupt protective physiologic responses or result in immunosuppression. Although it is unlikely that no single therapeutic strategy will ever be sufficient in of itself to totally prevent CPB-associated morbidity, the combination of multiple pharmacologic and mechanical therapeutic strategies, each selectively targeted at different components of the inflammatory response, may eventually result in significantly improved clinical outcomes following cardiac surgery.