Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2009
ReviewA practical guide to commonly performed ultrasound-guided peripheral-nerve blocks.
Regional anesthesia has experienced a tremendous renaissance of interest over the past several years. Much of this renewed enthusiasm among clinicians is due to the increased usage of ultrasound guidance for peripheral-nerve blocks. This review serves as a useful foundation for the most commonly employed ultrasound-guided blocks utilized by the clinician. ⋯ With ultrasound guidance, the regional anesthesiologist has yet another tool to enhance both the accuracy and success of peripheral-nerve blockade. This article serves to display the most clinically relevant nerve blocks utilized in the perioperative setting. It is meant to be used as a clinical starting point for the development of regional anesthesia skills.
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Curr Opin Anaesthesiol · Oct 2009
ReviewProcessed electroencephalogram in depth of anesthesia monitoring.
We critically review the principles underlying processed electroencephalogram (EEG) monitors and recent studies validating their use in monitoring anesthetic depth. ⋯ Current processed EEG monitors are limited by their calibration range and the interpatient variability in their dose-response curves. The next generation of depth-of-anesthesia monitors will require a greater understanding of the transformations of cortical and subcortical activity into EEG signals, the effects of anesthetics at a systems level, and the neural correlates of consciousness.
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Pediatric traumatic brain injury (TBI) is associated with significant morbidity and mortality. The purpose of this review is to discuss emerging concepts and to provide an update on the clinical evaluation, management, and predictors of outcome after pediatric TBI. ⋯ As TBI is the leading cause of death in children, research in this area is needed to advance our knowledge of the sequelae after and improve outcomes of children with TBI.
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Despite some controversy regarding the strength of the available data, the use of regional anesthesia and analgesia does provide improvement in patient outcomes. Although the majority of available data have examined the effect of epidural anesthesia and analgesia on patient outcomes, an increasing number of studies recently have investigated the effect of peripheral regional techniques on patient outcomes. ⋯ Perioperative use of regional analgesic techniques may provide improvement in conventional outcomes, although the benefit appears to be limited to high-risk patients and those undergoing high-risk procedures. The benefits conferred by perioperative regional anesthetic techniques need to be weighed against any potential risks and this should be assessed on an individual basis.