Anesthesiology clinics
-
Anesthesiology clinics · Dec 2007
ReviewDocumentation and potential tools in long-term opioid therapy for pain.
The field of pain medicine is experiencing increased pressure from regulatory agencies and other sources regarding the continuation, or even initial use, of opioids in pain patients. Therefore, it is essential that pain clinicians provide rationale for engaging in this modality of treatment and provide ample documentation in this regard. Thus, assessment and documentation are cornerstones for both protecting your practice and obtaining optimal patient outcomes while on opioid therapy. Several potential tools and documentation strategies are discussed that will aid clinicians in providing evidence for the continuation of this type of treatment for their patients.
-
This article concentrates on recent evidence about opioid analgesics for persistent noncancer pain. Evidence confirms that opioids are drugs with a definite risk of adverse events. ⋯ Strong opioids should be reserved for patients who fail to respond to other lower-risk options and only after proper consideration is given to the long-term consequences of strong opioid use. Problems associated with opioids dictate that more efficacious and safer drugs need to be found.
-
Anesthesiology clinics · Sep 2007
ReviewAnesthetic considerations for awake craniotomy for epilepsy.
A variety of anesthetic methods, with and without airway manipulation, are available to facilitate awake intraoperative examinations and cortical stimulation, which allow more aggressive resection of epileptogenic foci in functionally important brain regions. Careful patient selection and preparation combined with attentive cooperation of the medical team are the foundation for a smooth awake procedure. With improved pharmacologic agents and variety of techniques at the neuroanesthesiologist's disposal, awake craniotomy has become an elegant approach to epileptic focus resection in functional cortex.
-
Perhaps the greatest recent controversy in the medical management of complex neurologic and neurosurgical patients has been the defining of the optimal care arena. Despite some early skepticism and measured recognition by the ICU community, neurosciences critical care has grown into a well-recognized subspecialty. Within this environment, the diverse expertise of surgeons, neurologists, and anesthesiologists come together to define best therapeutic strategies. Two neurologic disease states that, in particular, continue to elicit expansive interdisciplinary debate are spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage.
-
Anesthesiology clinics · Sep 2007
Risks and benefits of patient positioning during neurosurgical care.
Positioning of the surgical patient is an important part of anesthesia care and attention to the physical and physiologic consequences of positioning can help prevent serious adverse events and complications. The general principles of patient positioning of the anesthetized and awake neurosurgical patient are discussed in this article.