Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewThe role of tetrastarches for volume replacement in the perioperative setting.
Current opinion in perioperative fluid therapy suggests that the use of colloids to achieve haemodynamic optimization may result in improved clinical outcomes. This has focused interest on the colloid solutions, particularly on the newest of these, the tetrastarches. This review will address the advantages and disadvantages of the starch solutions with particular emphasis on the advantages offered by the tetrastarches, as these products, which have been widely used in Europe for a number of years, have recently been released in the United States. ⋯ Tetrastarch represents a substantial advance in colloid therapy, offering good volume effectiveness with a very low risk of adverse effects.
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Curr Opin Anaesthesiol · Oct 2008
ReviewTranscranial Doppler ultrasonography: a diagnostic tool of increasing utility.
Since its introduction in 1982, transcranial Doppler ultrasonography has become an important diagnostic and monitoring tool in patients with surgical disease. It has applications in the perioperative period, as well as in the intensive care unit. It is therefore appropriate for the anesthesiologist to maintain an understanding of its current utility. ⋯ Although there are several settings in which transcranial Doppler has well established usefulness, there are many more in which it is likely valuable, such as traumatic brain injury, ischemic stroke, and fulminant hepatic failure. Further research is needed in these fields to elucidate the exact role for transcranial Doppler.
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The present review highlights new insights into indications and guidance during procedures for continuous peripheral nerve blocks. ⋯ Continuous peripheral nerve blocks are essential in the perioperative anesthetic management of in-hospital or ambulatory patients. Ultrasound guidance and stimulating catheters can help anesthetists during the procedure.
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Evidence from retrospective studies suggests that regional anesthesia reduces the risks of major complications associated with carotid endarterectomy compared with general anesthesia, namely: stroke, stroke/death, death and myocardial infarction. ⋯ The anesthesiologist should learn how to place a superficial cervical plexus block. The technique is easy to master, effective and carries a low risk of inducing a serious complication.
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Curr Opin Anaesthesiol · Oct 2008
ReviewDifferences between and combinations of opioids re-visited.
Recent studies highlighting between-opioid differences in patient outcomes, opioid receptor interactions and animal study findings implicating a 'fine control' mechanism underpinning potential diversity in opioid receptor signalling that could potentially be exploited to develop novel opioid analgesics with improved tolerability are reviewed. ⋯ Enhanced understanding of diversity in opioid signalling has the potential to produce novel strong opioid analgesics with improved tolerability.