Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2006
ReviewAntidepressants as local anesthetics: is there a place in regional anesthesia?
Antidepressants have multiple sites of action. Among these, the ability to inhibit sodium channels has led to the increased interest in their use as local anesthetics. The following review summarizes the results of recent studies on this topic. ⋯ Although antidepressants indeed act as potent local anesthetics, their use in the clinical setting cannot be recommended as of today due to extensive local tissue toxicity.
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Curr Opin Anaesthesiol · Oct 2006
ReviewWhy we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia.
Evolution of neurosurgery mainly trends towards minimally invasive and functional procedures including endoscopies, small-size craniotomies, intraoperative imaging and stereotactic interventions. Consequently, new adjustments of anaesthesia should aim at providing brain relaxation, minimal interference with electrophysiological monitoring, rapid recovery, patients' cooperation during surgery and neuroprotection. ⋯ Although all the objectives of neurosurgical anaesthesia cannot be met by one single anaesthetic agent or technique, propofol-based intravenous anaesthesia appears as the first choice to challenge the evolution of neurosurgery in the third millennium.
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Much effort has been taken to prove that a treatment initiated before surgery is more effective in reducing postoperative pain compared with the same intervention started after surgery. Clinical studies failed to demonstrate major clinical benefits of preemptive analgesia, however, and the results of recent systemic reviews are equivocal. The present review will discuss recent clinical as well as experimental evidence of preemptive analgesia and examine the implications of a preventive postoperative pain treatment. ⋯ Extending a multimodal analgesic treatment into the postoperative period to prevent postoperative pain may be superior compared with preemptive analgesia. In the future, appropriate drug combinations, drug concentrations and duration of preventive strategies need to be determined to be most beneficial for the management of acute and chronic pain after surgery.
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Curr Opin Anaesthesiol · Oct 2006
ReviewManagement of physiological variables in neuroanaesthesia: maintaining homeostasis during intracranial surgery.
The recent literature on the perioperative maintenance of cerebral homeostasis was reviewed. ⋯ From the clinical point of view, the recent research has added only little to the knowledge on the management of physiological parameters in neurosurgery. More adequately powered studies focusing in specific problems, and having a meaningful aim relative to outcome, are needed also in neuroanaesthesia.
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To review the techniques for imaging cerebral blood flow and metabolism following injury to the brain. ⋯ Imaging of cerebral blood flow and metabolism has been shown to be useful following a variety of causes of brain injury, as it can help to define the cause and extent of injury, identify appropriate treatments and predict outcome. Imaging based on CT techniques (Xenon CT and CT perfusion) can be implemented easily in most hospital centres, and are able to provide quantitative perfusion data in addition to structural images.