Articles: treatment.
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The role of anesthesia outside the operating room is rapidly expanding and evolving alongside with the advances in interventional neuroradiology. Increasingly complex diagnostic and therapeutic neuroradiological procedures are being performed on sicker patients. This review provides an overview of the principles of anesthetic management and summarizes recent advances in interventional neuroradiology. ⋯ Providing anesthesia in the interventional neuroradiology suite continues to be a challenge to the anesthesiologist. Understanding the anesthetic constraints and complexities and keeping abreast of the current developments in neuroradiology are crucial in ensuring the maximal benefits to and safety of patients.
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Cannabinoids have been known for their analgesic, anxiolytic, antiemetic and antispastic properties for many centuries. Since an endogenous cannabinoid system has been identified in the past two decades, cannabinoids have also become the focus of interest in western medicine. This review summarizes preclinical and clinical studies on the role of the endocannabinoid system and exogenous cannabinoids in anaesthesia and pain management. ⋯ In general, the results of the very few well-conducted clinical trials often diverge from the highly interesting and promising findings of preclinical studies. Taken together, the most recent preclinical and clinical data suggest that cannabinoids should be applied as low-dose co-analgesics to inhibit neuroplasticity and central sensitization rather than as analgesics in acute pain.
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Curr Opin Anaesthesiol · Aug 2005
Anaesthetics and the rate corrected interval: learning from droperidol?
Understanding of the long QT syndrome continues to evolve. Anaesthesia in patients with untreated long QT syndrome carries a risk of perioperative malignant ventricular arrhythmias. Genotypically susceptible individuals may have a normal rate-corrected QT interval and present with torsade de pointes intraoperatively. The likelihood of arrhythmias can be reduced by careful preoperative preparation. Perioperative disturbances in physiological homeostasis and drugs administered can prolong the rate-corrected QT interval. ⋯ Droperidol can lead to serious cardiac arrhythmias from QT prolongation. Recent advances in the pathophysiology of congenital and acquired long QT syndrome are reviewed. Preclinical tests assessing potential new drugs for QT prolongation are briefly discussed. Considerations for the management of these patients during perioperative phases are explored. The optimal treatment of the long QT syndrome is presented along with a glimpse into future possibilities in this field.
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Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. ⋯ Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.
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In recent years, transforaminal epidural injections have emerged as an alternative to interlaminar and caudal epidural steroid injections. The rationale for utilizing transforaminal epidural injections has been described for diagnostic as well as therapeutic purposes. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar nerve root pain is strong, whereas it is moderate in managing cervical nerve root pain. However, these techniques are also associated with rare, but catastrophic, neurologic complications. ⋯ This case report describes vascular injury leading to an infarction of the spinal cord following a thoracolumbar transforaminal epidural steroid injection. Alternative approaches to, or alternatives means of, performing transforaminal injections should be considered to avoid devastating neurological complications.