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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Thoracic epidural anesthesia (TEA) is most frequently used after major surgery. However, despite ongoing research, the influence of TEA on the intestinal perioperative pathophysiology is not fully understood. ⋯ Further research concerning the use of TEA in major laparoscopic procedures and its potential to improve or endanger anastomotic healing is warranted. The experimental studies of TEA in critical illness should be expanded.
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Curr Opin Anaesthesiol · Oct 2009
ReviewLocal anaesthetic adjuvants: neuraxial versus peripheral nerve block.
To present a review of the literature on the importance and the clinical characteristics relevant to adjuvants added to local anaesthetics in neuraxial and peripheral nerve blocks. ⋯ Opioids and alpha-2 receptor agonists are important as neuraxial adjuvants to improve the quality of peroperative and postoperative analgesia in high-risk patients and in ambulatory procedures. In peripheral nerve blocks, however, some benefit is found only when clonidine is added to local anaesthetics under certain circumstances.
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Curr Opin Anaesthesiol · Oct 2009
ReviewRole of N-methyl-D-aspartate receptor antagonists in postoperative pain management.
In recent years, hundreds of studies have examined the clinical efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and dextromethorphan as an adjunct to routine postoperative pain management. The purpose of this review is to describe the detail of the study that successfully demonstrated the efficacy of NMDA receptor antagonists. ⋯ The co-administration of ketamine and morphine as a mixture is not recommended for postoperative pain relief. As an adjunct in multimodal analgesia, low-dose ketamine infusion and the administration of dextromethorphan may be able to improve postoperative pain status. Memantine exhibits the greatest potency among NMDA receptor antagonists. In future, research should consider the perioperative infusion of ketamine followed by long-term administration of memantine for the prevention of persistent pain.