Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2009
ReviewPain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia.
To review the rational for use of the many regional anesthetic/analgesic techniques and acute pain management modalities in the elderly and cognitively impaired high-risk patients, as increasing numbers of older adults are presenting for surgery. ⋯ Pain management therapy, including regional anesthesia, along with multimodal analgesia may help reduce the risk of negative influences in the elderly patient along with reducing postoperative delirium and cognitive dysfunction. Improvements in analgesic efficacy with regional anesthesia may attenuate pathophysiological surgical responses, reduce the length of hospitalization, and accelerate patient rehabilitation and recovery. Analgesic techniques that provide optimal pain control and low side effect profiles with minimal opioid exposure should always be considered for elderly high-risk and cognitively impaired patients.
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Curr Opin Anaesthesiol · Oct 2009
ReviewLipid resuscitation for local anesthetic toxicity: is it really lifesaving?
Laboratory studies and clinical reports have led to the acceptance of lipid emulsion as an effective treatment of local anesthetic-induced cardiac arrest. This review discusses subsequent clinical reports, relevant laboratory studies and topics for further research. ⋯ Lipid emulsion infusion appears to be an effective treatment for cardiac toxicity induced by lipophilic medications. Given the difficulties of performing clinical trials, further laboratory investigation and clinical correlation are needed to better define its role in resuscitation.
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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.
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Curr Opin Anaesthesiol · Oct 2009
Review Comparative StudyBrachial plexus block with or without ultrasound guidance.
Should ultrasound or nerve stimulation be used for brachial plexus blocks? We investigated last year's literature to help answer this question. ⋯ We think that the literature gives a sufficient basis to recommend the use of ultrasound for guidance of brachial plexus blocks. The potential for ultrasound to improve efficacy and reduce complications of brachial plexus blocks requires larger scaled studies.
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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.