Current opinion in anaesthesiology
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In this article we aim to review the recent literature concerning the management of traumatic brain injury patients, summarize the main findings, and discuss the impact of these findings on clinical practice. ⋯ The key term for the management of traumatic brain injury patients in the early twenty-first century will clearly be 'individualized therapy'. The search of an ideal cerebral perfusion pressure target that would fit every head-injured patients is a utopia. More energy should be focused on the development of reliable tools for outcome prediction and outcome assessment for traumatic brain injured patients. That, and a better targeting of patients entering brain protective trials, should increase the likelihood of demonstrating a significant salvaging effect of a particular treatment in humans.
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This review was performed through a Medline research to evaluate articles published between January 2004 and April 2005. Technical procedures, indications, drugs, infusion regimens, and complications of continuous peripheral nerve blocks were considered. ⋯ Continuous peripheral nerve blockade is an effective and safe technique for postoperative analgesia, even when administered at home. To optimize this technique, further studies are needed to help minimize the risk of side effects, improve techniques to locate the targeted nerve (stimulating catheters or ultrasound imaging) and choose less toxic drugs (levobupivacaine and ropivacaine) with more effective infusion regimens.
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Neuropathic pain accounts for 25-50% of pain clinic visits with an estimated prevalence of 4 million. Neuropathic pain is often difficult to diagnose and treat with few pharmacologic options currently available. This review summarizes the latest research on the pathophysiology, diagnosis and treatment of neuropathic pain. ⋯ Neuropathic pain is common, underdiagnosed and undertreated. Diagnosing and understanding the basic mechanisms of neuropathic pain will lead to better treatments of this difficult health care problem.
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This article reviews recent advances in multimodality monitoring of patients following severe head injury during the period of 2004-2005. ⋯ Multimodality neuromonitoring plays an important role in managing patients with severe head injury. It helps guide treatment, provides prognostic information and explores the pathophysiology of evolving brain injury.
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Analysis of recent data indicates a clear benefit of carotid endarterectomy for symptomatic patients with high-grade carotid artery stenosis, and a marginal benefit for asymptomatic patients. Despite myriad challenges presented by patients undergoing carotid endarterectomy, excellent outcomes have been achieved and many centers have shown the technique to be safe as an outpatient procedure for specific populations. Greater attention to comorbidities and their management in the perioperative period is increasingly important as older and more complex patients present for invasive treatment of carotid disease. Scientific study aimed at defining which characteristics merit our attention will only lead to improved outcomes and greater understanding of carotid disease, endarterectomy and anesthesia. While controversial, the efficacy, safety, and durability of stenting and angioplasty have improved in recent years. Potential advantages of stenting and angioplasty of the carotid artery include avoiding cranial nerve damage, wound hematoma, and general anesthesia. Staying abreast of the science regarding such endovascular therapies will be increasingly important. ⋯ Patients with significant comorbidities may be managed safely by a variety of anesthetic techniques. Maintaining hemodynamic stability and monitoring cerebral oxygen delivery remain important goals of perioperative management. Recent data regarding the durability and safety of stenting and angioplasty of the carotid artery suggest that outcomes may approach those of carotid endarterectomy.