Current opinion in anaesthesiology
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Central neuropathic pain is an important and disabling but often neglected problem following central nervous system lesions. The present review highlights recent advances in the understanding of the underlying mechanisms and in the diagnosis and treatment of central pain. ⋯ Increased insight into the mechanisms of central pain will hopefully lead to increased efforts to study mechanism-based treatment of central pain.
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Curr Opin Anaesthesiol · Oct 2008
ReviewUpdate on the propofol infusion syndrome in ICU management of patients with head injury.
The propofol infusion syndrome is a rare condition characterized by the occurrence of lactic acidosis, rhabdomyolysis and cardiovascular collapse following high-dose propofol infusion over prolonged periods of time. Patients with traumatic brain injury are particularly at risk of developing this complication because large doses of propofol are commonly used to control intracranial pressure, whereas vasopressors are administered to augment cerebral perfusion pressure. In this review, we provide an update on the literature with particular emphasis on patients with traumatic brain injury. ⋯ Propofol infusion syndrome is a rare but frequently lethal complication of propofol use. In patients with risk factors, such as traumatic brain injury, it is suggested that an infusion rate of 4 mg/kg per hour should not be exceeded. Early warning signs include unexplained lactic acidosis, lipemia and Brugada-like ECG changes. When these occur, propofol infusion should be discontinued immediately.
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Curr Opin Anaesthesiol · Oct 2008
ReviewMultimodality monitoring of the central nervous system using motor-evoked potentials.
This review was conducted to examine the role of motor-evoked potential monitoring in spine and central nervous system surgery to determine whether other monitoring modalities such as the wake-up test or somatosensory-evoked potentials can be eliminated. ⋯ The literature supports the use of multimodality monitoring using all of the electrophysiological techniques that can provide intraoperative information about the neural structures at risk during the surgery.
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The use of ultrasound for peripheral nerve blockade is becoming popular. Although the feasibility of ultrasound-guided nerve blockade is now clear, it is uncertain at this time whether it represents the new standard for regional anesthesia in terms of efficacy and safety. ⋯ Ultrasound is a valuable tool that is now available to the regional anesthesiologist, and it is fast becoming a standard part of practice. It promises to be of especial value to the less experienced practitioner. Ultrasound does not in itself, however, guarantee the efficacy and safety of peripheral nerve blockade. Proper training in its use is required and we can expect to see the development of formal standards and guidelines in this regard.