Current opinion in anaesthesiology
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Regional anesthesia is commonly used to provide intraoperative anesthesia and postoperative analgesia. Potential complications of both neuraxial and peripheral regional techniques include infectious sequelae. This review examines important components of practice that are known to minimize the risk of infection associated with regional anesthesia. ⋯ Infectious complications associated with regional anesthesia are exceedingly rare events. Adherence to strict aseptic guidelines as published by the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, and the Royal College of Anaesthetists may reduce the risk of infectious complications.
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Curr Opin Anaesthesiol · Oct 2011
ReviewPhantom limb pain and bodily awareness: current concepts and future directions.
Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management. ⋯ Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.
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Curr Opin Anaesthesiol · Oct 2011
ReviewAneurysmal subarachnoid hemorrhage: an update on the medical complications and treatments strategies seen in these patients.
Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with high mortality and poor outcome among survivors. Early surgical or endovascular securing of the aneurysm is the norm, and management of these patients is precarious due to their unstable intracranial physiology and the severe systemic medical complications common in SAH. ⋯ Growing knowledge of the physiologic derangements associated with poor outcomes in SAH can improve our understanding of the widespread physiologic changes occurring with SAH and with further research, may provide clinicians with a direction for increasingly meaningful intervention. Ongoing investigation of our current therapeutics enable clinicians to apply them more judiciously to suitable patients, thereby enhancing the benefit and minimizing the complications of such treatments. Furthermore, by re-evaluating previously disproved treatments through the use of novel regimens or administration routes, promising treatment options are emerging.
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Curr Opin Anaesthesiol · Oct 2011
ReviewUltrasonography of the lumbar spine for neuraxial and lumbar plexus blocks.
Ultrasonography of the spine has evolved into a well described technique that can be applied to facilitate neuraxial and lumbar plexus blockade. ⋯ Preprocedural ultrasound imaging of the spine may reduce the technical difficulty of neuraxial blockade and also improve clinical efficacy. Similar benefits are expected in the setting of lumbar plexus blockade although there is currently no evidence to confirm this. Real-time ultrasound-guided neuraxial and lumbar plexus blockade are challenging techniques that need further validation.
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Curr Opin Anaesthesiol · Oct 2011
ReviewAnesthetic concerns for pediatric patients in an intraoperative MRI suite.
Intraoperative magnetic resonance imaging (iMRI) is an evolving technology used to provide precise intraoperative navigation during a variety of neurosurgical and other types of surgical procedures. Anesthesiologists need to be aware of the unique challenges created by this environment. Failure to recognize the differences between the diagnostic MRI environment and the iMRI environment can compromise the safety of the patient and operating room staff and present logistical problems. ⋯ We describe the design of different iMRI suites as well as provide a breakdown of both patient and equipment issues encountered by anesthesiologists practicing in this environment. Finally, we offer our ongoing experience in this environment and provide suggestions to optimize patient outcomes.