Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2010
ReviewConditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states.
There is a growing body of knowledge on pain modulation in various disease states. This article reviews the state of the art regarding the clinical relevance of pain inhibition as revealed by 'pain inhibits pain' test paradigms, trying to organize the clinically relevant data, and emphasizing the pathophysiology of pain. In line with recent experts' recommendations, the term conditioned pain modulation (CPM) will be used, replacing the previous terms 'diffuse noxious inhibitory control (DNIC)' or 'DNIC-like' effects. ⋯ Low CPM efficiency is associated with higher pain morbidity and vice versa. Further work is awaited on clarifying plasticity of CPM and its relevance to selection and efficacy of pain therapy.
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Investigate the rational for incorporation of regional anesthesia techniques into a multimodal approach toward patients with co-existing chronic pain as increasing numbers of chronic pain patients are presenting for surgery. ⋯ The systemic condition of chronic pain has important practical and clinical implications for regional anesthesia implementation by anesthesiologists and pain management physicians. Comprehensive preadmission assessment together with a complete medication history and close follow-up management should always be employed in patients with pre-existing chronic pain throughout the perioperative setting. Despite successful implementation of neural blockade, and to avoid opioid withdrawal, at least half the chronic pain patient's daily pre-admission opioid dose should be continued daily throughout the perioperative period. Regional anesthesia is a preferable anesthetic option for perioperative management technique of patients with co-existing chronic pain, even if it requires supplementation with sedation or general anesthesia. The specifics of regional anesthesia performance and practical strategies for regional anesthesia application in chronic pain patients, including implanted pain management devices, are reviewed in this study.
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Postoperative vision loss (POVL) as related to spinal surgery and the prone position has garnered increasing attention in the US over the last 15 years, resulting in an increase of litigations submitted to the legal system. It might be associated with the development of new surgical techniques involving complex instrumentation of the spine. By 2000, the magnitude of this problem was such that the American Society of Anesthesiologists developed a Postoperative Visual Loss Registry in an effort to better understand and evaluate this devastating operative complication. ⋯ ION is still poorly understood and risk factors remain speculative. Given that there is no known treatment, increased understanding should help to prevent this postoperative complication.
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Curr Opin Anaesthesiol · Oct 2010
ReviewAntiepileptic drug therapy in the perioperative course of neurosurgical patients.
Antiepileptic agents are widely used in the perioperative course of neurosurgical patients - for prophylactic and therapeutic reasons. However, the evidence supporting their use is extremely small and adverse events are common. This review highlights the current controversies. ⋯ Despite lacking evidence, prophylactic antiepileptic drug use is common in the perioperative course of neurosurgical patients. More research is needed to deal better with epileptogenesis and to define the right drug for the right patient at the right time.