Articles: anesthetics.
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Moderate-to-severe pain is common and remains a significant problem. Compared with opioid analgesia alone, single-shot peripheral nerve blockade has been associated with improved pain relief and the potential of decreased side effects. Single-shot nerve blockade, however, is limited by its relatively short duration of action. In this review, we aim to summarize the evidence related to local anaesthetic adjuncts for peripheral nerve blockade. ⋯ Intravenous dexamethasone is the local anaesthetic adjunct of choice, increasing the duration of sensory and motor blockade as well as the duration of analgesia by 477, 289 and 478 min, respectively. In view of this, we recommend consideration of the intravenous administration of dexamethasone at a dose of 0.1-0.2 mg/kg for all patients undergoing surgery whatever the level of postoperative pain, mild, moderate or severe. Further research should focus on the potential synergism of action between intravenous dexamethasone and perineural dexmedetomidine.
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Curr Pain Headache Rep · Oct 2023
ReviewKetamine for Chronic Pain and Mental Health: Regulations, Legalities, and the Growth of Infusion Clinics.
In this article, we will review evidence for ketamine's role in chronic pain and mental health conditions, its current legal status and abuse potential, and the regulations related to its administration in stand-alone infusion clinics, as well as future considerations. ⋯ In the management of chronic pain, ketamine has shown potential to manage neuropathic pain and complex regional pain syndrome and has been used as a treatment for chronic pain management by clinics across the USA. Analogous to the historic rise of lidocaine clinics, ketamine clinics are demonstrating a similar pattern of unregulated growth. Ketamine is an anesthetic and analgesic agent commonly used in the perioperative setting and emergency department for sedation and pain management (Mo et al in West J Emerg Med 21(2):272-281, 2020). It was approved for use by the Federal Drug Administration in the USA in the 1970s as the sole anesthetic agent for short diagnostic and surgical procedures (Coppel et al. in Anaesthesia 28(3):293-296, 1973; Schwenk et al. in Reg Anesth Pain Med 43(5):456-466, 2018). Regarding its rising popularity as a treatment option in mental health, ketamine holds promise as a rapidly acting treatment for suicidal ideation and refractory depression.
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Editorial Comment Review
Consensus guidelines, Delphi methods, and evidence around anaesthetic technique for endoscopic retrograde cholangiopancreatography.
Consensus guidelines on the anaesthetic management of endoscopic retrograde cholangiopancreatography (ERCP) have recently been published. The rigorous synthesis of expert opinion is invaluable when there are limited data, and these guidelines are a significant step forward. This review both guides practice and identifies important research questions. We challenge those working in this field to collaborate and produce the evidence for whether monitored anaesthesia care (MAC) is associated with a lower incidence of adverse events and better outcomes than general anaesthesia for ERCP.
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Curr Opin Anaesthesiol · Oct 2023
ReviewGeneral purpose models for intravenous anesthetics, the next generation for target-controlled infusion and total intravenous anesthesia?
There are various pharmacokinetic-dynamic models available, which describe the time course of drug concentration and effect and which can be incorporated into target-controlled infusion (TCI) systems. For anesthesia and sedation, most of these models are derived from narrow patient populations, which restricts applicability for the overall population, including (small) children, elderly, and obese patients. This forces clinicians to select specific models for specific populations. ⋯ This article examines the usability of these general-purpose models in relation to the more traditional models.
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Curr Opin Anaesthesiol · Oct 2023
ReviewModulating anesthetic emergence with pathway-selective dopamine signaling.
To summarize the recent preclinical findings investigating dopaminergic circuits for their involvement in reversing anesthetic-induced unconsciousness. ⋯ Potential avenues for accelerating anesthetic emergence may be found through targeting specific arousal-promoting pathways in the brain. Accumulating evidence from rodent studies manipulating cell type- and circuit-specific signaling pathways have identified dopamine as a potent modulator of general anesthesia. Specifically, dopamine signaling along the mesolimbic and mesocortical pathways plays a fundamental role in regulating consciousness.