Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2013
ReviewAssessment and management of rib fracture pain in geriatric population: an ode to old age.
Pain management for traumatic rib fractures has been described in literature, but there is paucity of data when it comes to acute pain management in the elderly, let alone pain resulting from traumatic rib fractures. ⋯ The goal is to devise a proper pain management regimen for geriatric patients with rib fractures to decrease the morbidity and mortality associated with it. Developing institutional protocols is one step forward towards quality care for such patients.
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Pituitary tumors are commonly encountered in clinical practice. Patients with functioning adenomas frequently present with symptoms of hormone excess, whereas those with nonfunctioning adenomas often present later and have symptoms resulting from mass effect of the tumor. This article examines recent advancements in the preoperative assessment and anesthetic management of patients undergoing transsphenoidal pituitary surgery. ⋯ Anesthetic management for pituitary surgery requires thorough preanesthetic assessment of hormonal function and intraoperative management to facilitate surgical exposure while providing hemodynamic stability and allowing for rapid emergence.
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Every year, millions of children undergo anesthesia. Emerging evidence from experimental in-vitro and in-vivo models supports a role for neuropathologic injury and neurobehavioral deficits at older age after early exposure to various anesthetic regimens. Clinical studies have sought to identify a phenotype of developmental anesthesia neurotoxicity in humans, but the current evidence is limited to data from retrospective studies with their associated confounders. Experimental models have been used to further define the injury and to help identify potential mechanisms of this neurotoxicity. ⋯ Whether anesthesia-associated neurotoxicity affects the developing human brain and whether this leads to clinically measurable deficits remains unclear.
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A major challenge in the treatment of brain-injured patients is the decision on indication and timing of prophylactic anticoagulation. In addition, an increasing number of patients suffering from traumatic brain injury (TBI) are on preinjury anticoagulation therapy. Despite clear evidence for an increased risk of venous thromboembolic events and pulmonary embolism in traumatized patients without prophylactic anticoagulation, there is a lack of distinct recommendations and standardized clinical practice guidelines. This review summarizes current research evidence regarding post-traumatic prophylactic anticoagulation and management of patients with prehospital use of anticoagulants. ⋯ Stratification scores for identification of TBI patients with low, moderate, or high risk for spontaneous cerebral bleeding may help to allow early thromboprophylaxis while maintaining a good risk-benefit ratio. So far, these scores require validation by prospective trials. Therefore, current evidence requires control computed tomography scans prior to early pharmacological thromboprophylaxis.
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Curr Opin Anaesthesiol · Oct 2013
ReviewUltrasound guidance, a win-win approach to peripheral nerve blockade.
The objective of the current review is to examine the likelihood of improved safety in peripheral nerve blockade attributable to ultrasound guidance. ⋯ Ultrasound is clearly superior to other techniques with the aim of achieving maximum efficacy with minimum risk: a win-win approach.