Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2013
ReviewEpidural steroids for spinal pain and radiculopathy: a narrative, evidence-based review.
Epidural steroid injections (ESIs) are the most commonly performed intervention in pain clinics across the USA and worldwide. In light of the growing use of ESIs, a recent spate of highly publicized infectious complications, and increasing emphasis on cost-effectiveness, the utility of ESI has recently come under intense scrutiny. This article provides an evidence-based review of ESIs, including the most up-to-date information on patient selection, comparison of techniques, efficacy, and complications. ⋯ The cost-effectiveness of ESI is the subject of great debate, and similar to efficacy, the conclusions one draws appear to be influenced by specialty. Because of the wide disparities regarding indications and utilization, it is likely that indiscriminate use is cost-ineffective, but that judicious use in well-selected patients can decrease healthcare utilization. More research is needed to better refine selection criteria for ESI, and to determine which approach, what dose, and how many injections are optimal.
-
Targeted intrathecal drug delivery systems (IDDS) are an option in algorithms for the treatment of patients with moderate-to-severe chronic refractory pain. This article is intended to review the literature regarding IDDS published over the last year, with special attention to the Polyanalgesic Consensus Conference 2012. ⋯ This review includes the recommendations for the use of IDDS, trialing, and recent reports of complications (especially, the occurrence of granulomas). In addition, the latest documents on cerebrospinal fluid and potential lines of future development are discussed.
-
Curr Opin Anaesthesiol · Oct 2013
ReviewThe new technological trends in ultrasound-guided regional anesthesia.
Real-time two-dimensional ultrasound guidance is undoubtedly one of the most important evolutions in the field of regional anesthesia techniques, for peripheral nerve blocks and neuraxial anesthesia. The recent literature has been analyzed for studies concerning new technological trends in ultrasound-guided regional anesthesia. This review focuses on electromagnetic tracking systems for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia. ⋯ This article describes the principles, technology and development of electromagnetic tracking system for ultrasound guidance and three/four-dimensional ultrasound imaging in regional anesthesia, considering whether these new technologies will have impending applications in clinical practice.
-
This article reviews the current state of knowledge in functional MRI (fMRI) research related to pain with primary focus on clinical studies. ⋯ As we learn more about fMRI related to pain, functional connectivity patterns could emerge as biomarkers for specific pain conditions.
-
It is generally accepted that carotid endarterectomy (CEA) reduces the risk of stroke in symptomatic patients, with less risk reduction for asymptomatic patients. Although the comorbidities of these patients combined with the hemodynamic goals for the procedure pose unique perioperative challenges, patients undergoing CEA attain excellent outcomes. Nonetheless, heightened focus on perioperative management of comorbidities is increasingly important as older and more complex patients present with carotid artery disease. Although controversial, the efficacy, safety, and durability of carotid angioplasty and stenting (CAS) have been better defined in recent years. The 2012 literature presents several developments in the anesthetic management of CEA. Selected publications regarding CAS are also reviewed. ⋯ Patients with significant comorbidities may be managed safely by a variety of anesthetic techniques. Maintaining focus on physiologic management, and monitoring the brain remain important goals of perioperative management. Recent data suggest that the durability and safety of CAS are not inferior to those of CEA.