Current opinion in anaesthesiology
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Sitting position to surgically approach posterior fossa disorder continues to be the first choice for some neurosurgical teams. We underwent a literature research for recent published studies involving neurosurgical patients operated on in this position. Preoperative evaluation, anesthetic technique, intraoperative monitoring, detection and treatment of venous or arterial air embolism episodes, and all the reported complications were recorded. ⋯ Sitting position for neurosurgical procedures may be a well tolerated approach for the patient if neurosurgeons and neuroanesthesiologists undergo a strict team protocol, including all necessary monitoring and meticulously followed.
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Curr Opin Anaesthesiol · Oct 2014
ReviewWhat's new in the management of traumatic brain injury on neuro ICU?
In recent years, we have begun to better understand how to monitor the injured brain, look for less common complications and importantly, reduce unnecessary and potentially harmful intervention. However, the lack of consensus regarding triggers for intervention, best neuromonitoring techniques and standardization of therapeutic approach is in need of more careful study. This review covers the most recent evidence within this exciting and dynamic field. ⋯ Neurocritical care management of traumatic brain injury continues to evolve. However, it is important not to use a 'one-treatment-fits-all' approach, and perhaps look to use targeted therapies to individualize treatment.
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To explore the recent advances in the use of ultrasound for lower extremity blocks, including approaches to the lumbar and sacral plexus blocks. ⋯ Lower extremity blocks under ultrasound guidance often require advanced skills because of the depth of target nerves. This review summarizes the recent advances in the use of ultrasound guidance over traditional techniques.
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Curr Opin Anaesthesiol · Oct 2014
ReviewSpinal anesthesia revisited: toxicity of new and old drugs and compounds.
Neural toxicity of substances injected into the intrathecal space has been a matter of debate since the introduction of spinal anesthesia in clinical practice. In recent years, new local anesthetics and adjuvants have been proposed for intrathecal use, and new techniques such as the use of ultrasound have been propagated. The present review summarizes recent clinical and experimental data on the neurotoxic effects of drugs and substances used for or in conjunction with spinal anesthesia. ⋯ Clinical data suggest a high safety profile for intrathecal drugs and substances used for or in conjunction with spinal anesthesia. Recent experimental models for toxicity have provided further insight into the mechanisms and demonstrated possible, albeit clinically small differences in the relative neurotoxic potential of intrathecal drugs. This may contribute to a further increase in the safe use of spinal anesthesia in the clinical setting.
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The review highlights recent data regarding the safety and efficacy of endovascular treatment of cerebrovascular disease and concerns in anesthesia management. ⋯ Recent data further support the role of endovascular coiling for ruptured aneurysm in broader patient populations. Further studies are needed to investigate the proper management of unruptured arteriovenous malformations, and the key factors in endovascular therapy and anesthesia management associated with stroke outcome.