Current opinion in anaesthesiology
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Patients at risk for perioperative stroke, or those who have suffered recent cerebral injury, may benefit from neuroprotective properties of anesthetic agents during surgery. This manuscript reviews recent clinical and experimental evidence for neuroprotective effects of common anesthetic agents, and presents potential mechanisms involved in anesthetic neuroprotection. ⋯ Solid experimental evidence supports neuroprotection by anesthetic agents. It is too early to recommend any specific agent for clinical use as a neuroprotectant, however. Further study is warranted to unravel relevant mechanisms and to appreciate the potential clinical relevance of experimental findings.
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The ongoing debate on the outcome benefits of regional anaesthesia and analgesia over general anaesthesia and systemic analgesia has led to a large number of recently published papers, in particular systematic reviews and meta-analyses that justify a review of the current status of the debate. ⋯ Although there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anaesthesia on outcome is not completely resolved, possibly because the data are often not procedure specific. In addition, however, it may be that our current literature cannot provide a definitive answer.
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Clinicians are actively looking for an effective brain protection technique. With pharmacologic agents, several phase III trials in stroke, severe traumatic brain injury, and post-cardiac arrest survivors have failed. Hence there is renewed interest in mild to moderate hypothermia for brain protection. Phase III clinical trials with hypothermia have been successful only in post-cardiac arrest survivors and neonatal hypoxic encephalopathy. This review focuses on the possible reasons for our inability to translate into positive clinical trials what is observed consistently in laboratory models. ⋯ Hypothermia can at present be recommended only for post-cardiac arrest survivors and in neonatal hypoxic encephalopathy.
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The use of regional anesthesia, either alone or as an adjunct to general anesthesia, is at an all-time high. Demonstrated benefits include reduced side effects, more efficient use of facilities and enhanced patient satisfaction with the improved postoperative pain relief. New advances in equipment, techniques and medications have been incorporated over the past 10 years, and especially over the last 2 years. As the number of practitioners and procedures increase, the number of complications may rise as well. ⋯ Specific needle shapes, appropriate pharmacologic resuscitation from intravascular injection of local anesthetics and institutional procedures to positively identify patients and the correct block location are all part of a strategy to minimize the occurrence of adverse outcomes and to mitigate the consequences of those adverse events when they do occur. More importantly, these are changes that can be instituted immediately with minimal expense to the institution and great benefit to the patient.
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Curr Opin Anaesthesiol · Oct 2006
ReviewInhalational or intravenous anesthetics for craniotomies? Pro inhalational.
In neurosurgery, anesthesiologists and surgeons focus on the same target - the brain. The nature of anesthetics is to interact with brain physiology, leading to favorable and adverse effects. Research in neuroanesthesia over the last three decades has been dedicated to identifying the optimal anesthetic agent to maintain coupling between cerebral blood flow and metabolism, keep cerebrovascular autoregulation intact, and not increase cerebral blood volume and intracranial pressure. ⋯ In neurosurgical patients with normal intracranial pressure, sevoflurane might be a good alternative to propofol. In patients with reduced intracranial elastance, caused by space occupying lesions, with elevated intracranial pressure or complex surgical approaches, propofol should remain first choice.