Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2010
ReviewNoninvasive cerebral oximetry: is there light at the end of the tunnel?
There is increasing interest in the application of near infrared spectroscopy (NIRS) as a noninvasive monitor of cerebral oxygenation. This review will briefly describe the principles of NIRS and examine current evidence for its clinical application as a monitor of the adequacy of cerebral oxygenation in adults. ⋯ NIRS offers noninvasive monitoring of cerebral oxygenation over multiple regions of interest in a wide range of clinical scenarios. It has many potential advantages over other neuromonitoring techniques, but further technological advances are necessary before it can be introduced more widely into clinical practice.
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Curr Opin Anaesthesiol · Oct 2010
ReviewCurrent concepts and future trends in ultrasound-guided regional anesthesia.
Ultrasound guidance for regional anesthesia has gained enormous popularity during the past several years. This review article highlights the importance of acquiring an understanding and knowledge of human anatomy for well tolerated and effective performance of regional anesthesia; includes description of some of the major principles of ultrasound-guided regional anesthesia techniques (adequate identification of neuronal and adjacent anatomical structures along with the procedure needle); use of adequate volumes of local anesthetic and the proper administration of local anesthetic; and discusses economical along with educational aspects of ultrasound-guided regional blocks. ⋯ With little reservation, it is anticipated that ultrasound-guided regional anesthesia will become the 'GOLD' standard for performance of regional anesthesia. Excellent science and educational concepts will continue to be required with the continued increase in popularity of this exciting specialty of anesthesia.
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Curr Opin Anaesthesiol · Oct 2010
ReviewOpioid antagonists for prevention and treatment of opioid-induced gastrointestinal effects.
The therapeutic action of opioid analgesics is compromised by peripheral adverse effects, among which constipation is the most disabling as laxatives often fail to provide satisfactory relief. This review highlights recent advances in the specific control of opioid-induced constipation by opioid receptor antagonists with limited systemic bioavailability or a peripherally restricted site of action. ⋯ The availability of opioid receptor antagonists with restricted access to the central nervous system provides a novel opportunity to specifically control opioid-induced constipation and other peripheral adverse effects of opioid analgesics. Further studies are needed to evaluate the long-term efficacy, safety and cost-effectiveness of this approach.
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Curr Opin Anaesthesiol · Oct 2010
ReviewIs nitrous oxide use appropriate in neurosurgical and neurologically at-risk patients?
To address controversial issues surrounding the use of nitrous oxide as a component of anesthesia in neurosurgical and neurologically at-risk patients. ⋯ Except in a few specific circumstances, there exists no conclusive evidence to support the dogmatic avoidance of nitrous oxide in neurosurgical patients.
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Curr Opin Anaesthesiol · Oct 2010
ReviewThe clinical (ir)relevance of opioid-induced immune suppression.
Opioid-induced immune suppression has been demonstrated in cell culture experiments and in animal models. This review examines whether opioids also increase the risk of infections in the perioperative setting or on the ICU. ⋯ In contrast to in-vitro studies and to animal models, conclusive evidence is currently lacking that opioids induce clinically relevant infectious complications in patients. However, these findings should be interpreted with great caution, as almost no adequately designed trials have been performed. Peripherally selective opioid receptor antagonists might be useful if opioid-induced immune suppression should prove to be clinically relevant.