Current opinion in anaesthesiology
-
In this review we focus on recent findings in the anesthetic management of patients undergoing craniotomy while awake, and propose a structured approach to the clinical practice of 'anesthesia' for awake neurosurgery. ⋯ Although anesthesia for awake craniotomy is usually a well tolerated procedure it requires an extensive knowledge of the principles underlying neuroanesthesia and of specific technical strategies including local anesthesia for scalp blockade, advanced airway management, dedicated sedation protocols, and skillful management of hemodynamics.
-
Curr Opin Anaesthesiol · Oct 2009
ReviewParavertebral block: cervical, thoracic, lumbar, and sacral.
This article outlines the new developments around all four types of paravertebral block: cervical, thoracic, lumbar, and sacral. ⋯ We discuss commonality and differences between the four types of paravertebral blocks, and newer indications and concerns, especially pertaining to nerve microanatomical differences, are highlighted.
-
Perioperative transfusion thresholds in the neurosurgical patient are undefined. Many neurosurgical procedures are associated with significant risk of bleeding. This review will summarize the current understanding of blood transfusion in the neurosurgical patient, as well as other blood component therapies and blood conservation strategies. ⋯ Perioperative transfusion management for intracranial neurosurgical procedures presents the clinician with multiple challenges. Clinical evidence is sparse with view to an optimal hemoglobin level, yet anemia is known to be a predictor of poor outcome in many neurosurgical patients. Transfusion thresholds from other patient populations may not apply to this group and further prospective investigations are desperately needed. Until then, clinicians should focus on an individualized assessment of anemia tolerance, consider blood conservation strategies and understand the potential risks and benefits of blood transfusion.
-
Curr Opin Anaesthesiol · Oct 2009
ReviewAcute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes.
Patients with fibromyalgia are at increased risk to experience increased and prolonged postoperative pain. In this review, we will provide an overview of pathophysiological characteristics of fibromyalgia relevant for enhanced pain processing after surgery. Furthermore, we will present some potential treatment options in the perioperative period based on specific symptoms of individual fibromyalgia patients to optimize their pain management after surgery. ⋯ The perioperative pain management of patients with fibromyalgia is challenging and should include symptom-based approaches to target enhanced central sensitization and decreased inhibition in these patients as well as their psychological syndromes aiming to decrease acute and prolonged pain after surgery.