Acta chirurgica Iugoslavica
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Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be undertreated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.g. opioids, nonsteroidal antiinflammatory agents) analgesic options. ⋯ Ideally, analgesics, sedatives and/or muscle relaxants should be combined into a multimodal approach to facilitate patient recovery after surgery. Although a great deal is known about specific drugs and dosage requirements, further research is needed that clearly examines optimal scheduling regimens if we are to maximize patient care. The most important rule of pain management is that pain is what the patient says it is.
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Neuralgias of the lower cranial nerves are trigeminal neuralgia (TN), glossopharingeal neuralgia (GphN), and geniculate neuralgia (GN). Microsurgical posterior fossa exploration with its variations microvascular decompression (MVD), partial sensory rhisotomy (PSR), and total sensory rhisotomy (TSR) is one of the most efficient ways of treating these neuralgias. It was performed 130 operations in 125 patients with TN, 3 in GphN patients, 1 in GN patient, 1 in GN/TN patients, 1 in GphN/GN patient, and 2 in GN/hemifacial spasm patients. ⋯ There is no difference in complete pain relief, rate of recurrence, and complications between MVD, MVD+PSR and PSR operative groups (p0.05). Among patients with other neuralgias the following results are noted: excellent in 4, good in 3, and poor in 1 patient. Microsurgical posterior fossa exploration is the method of choice in the treatment of the neuralgias of the lower cranial nerves.
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Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) contribute to progressive hypoxemia in critically ill patients. It has been proved that conventional mechanical ventilation with physiological respiratory volume contributes to further lung damage. In this respect, application of protective ventilatory strategy--pulmonary ventilation with limited volume and pressure can avoid mentioned consequences. The aim of this paper is to discuss mechanims by which elements contained in protective mechanical ventilation of patients with ALI/ARDS prevent further progrssive lung injury, to argue the effects of positive end--expiratory pressure and present insturctions for its application.
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Mechanical properties of the spinal cord tissue--biological basis for the development of the modality of the DREZ surgery lesioning technique Succesful treatment of the chronic neurogenic pain of spinal cord and cauda equina injury origin remains a significant management problem. The mechanism of this pain phenomenon has been shown to be related to neurochemical changes that lead to the state of hypereactivity of the second order dorsal horn neurons. The DREZ surgery (Dorsal Root Entry Zone lesion), designed to destroy anatomy structures involved in pain generating thus interrupting the neurogenic pain mechanism, as a causative procedure in treating this chronic pain, has been performed by using different technical modalities: Radiofrequency (RF) coagulation technic, Laser, Ultrasound and Microsurgical DREZotomy technic. ⋯ Operative experimental testing and hystological analysis confirmed expected size and shape of the DREZ lesion performed by dorsal horn suction as DREZ lesioning technique. The utility, selectivity and safety of this technic has been provided by the natural mechanical properties of the cord tissue itself. Application of the Dorsal horn suction as a DREZ lesioning in humans confirmed this technic as a safe and reliable DREZ lesioning method.
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[DREZ (dorsal root entry zone) surgery for the treatment of the postherpetic intercostal neuralgia].
Postherpetic intercostal neuralgia proved to be an incapacitating pain often recalcitrant to therapy. Acute pain that accompanied Herpes zoster usually subsides spontaneously but in 10% of patients the pain persists and intensifies. The incidence of postherpetic neuralgia incrises up to 50% among elder patients. ⋯ DREZ surgicall treatment of this pain should be considered when medical therapies failed in controling pain. Subjective sensory nature of the pain should play an important role in setting the indication for DREZ surgical treatment. The most favourable pain pattern for DREZ operation is the pain of intermittent rhythm, confined theritory accompanied with the phenomenon of alodinic pain that could be provoked from the pain theritory.