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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In today's anesthesia practice, provision of neuraxial anesthesia and analgesia is increasing. Along with the patient's fear of paralysis that accompanies placement of a needle near the spinal cord, any subsequent nerve deficit is usually blamed on the neuraxial block provided. Knowing the side effects from labor, neuraxial anesthesia or both is important as anesthesiologists are the first consultants to evaluate whenever a complication arises in these patients if there is a sensory or motor deficit in the lower extremities. ⋯ Even though the incidence of true neurologic complications arising from neuraxial anesthesia is not known, they appear to be very rare. As anesthesiologists, providing care encompasses knowing the side effects and complications of the anesthetic we provide. Many of the nerve palsies that present in the postpartum patient may be of an obstetric origin, but anesthesiologists should be aware of anesthetic-related complications.