Current opinion in anaesthesiology
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The choice of local anesthetics in regional anesthesia depends on desired onset, intensity, and duration of block, as well as possible adverse effects. This review highlights recent advances in day-case spinal anesthesia; considerations in selecting local anesthetic volume, concentration, and mass in peripheral nerve blockade; and the pharmacokinetics of ropivacaine. ⋯ There are effective alternatives to bupivacaine in day-case spinal anesthesia but more safety and outcome data are required, particularly for 2-chloroprocaine. The trend toward smaller doses of local anesthetics in ultrasound-guided regional anesthesia improves safety but should be weighed against possible reductions in speed of onset and analgesic duration. Strategies to reduce the risk of local anesthetic systemic toxicity should be employed when performing large-volume fascial plane blocks with ropivacaine.
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Curr Opin Anaesthesiol · Aug 2014
ReviewAnesthesia in neurologic and psychiatric diseases: is there a 'best anesthesia' for certain diseases?
Patients with diseases affecting the central nervous system present a wide range of clinical manifestations increasing the perioperative risk. The following review focused on recommendations for anaesthesiological management in patients with both neurologic and psychiatric diseases. ⋯ The 'best' anesthesia includes adequate preoperative evaluation of the individual risk, optimization of comorbidities before elective surgery, the use of short-acting anesthetic agents for induction and maintenance of general anesthesia, avoidance of volatile agents and succinylcholine in muscular dystrophy and myopathies.
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In the last decade, there has been a rapid development in new endovascular treatment options for cerebral aneurysms. These techniques have their own inherent risk and can be challenging for the attending anesthetist. ⋯ The different endovascular techniques relevant to the anesthetist, the anesthetic options and complications that can occur during endovascular treatment of these patients will be discussed. This article can be a guidance to the anesthesiologist attending endovascular procedures for cerebral aneurysms.