Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2015
ReviewAcute pain assessment tools: let us move beyond simple pain ratings.
This review highlights challenges and current trends in tools used to assess acute pain across the lifespan. ⋯ Valid and pragmatic assessment of pain is essential for effective pain management. Unidimensional scales that capture self-reported pain intensity ratings undervalue to the complexity of the pain experience. Pain is a biopsychosocial experience and assessment is a complex social transaction and an exchange of the meaning of pain that demands a more comprehensive approach.
-
Curr Opin Anaesthesiol · Oct 2015
ReviewTraumatic brain injury: physiological targets for clinical practice in the prehospital setting and on the Neuro-ICU.
Over many years, understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. The present review revisits the evidence for these targets and therapies. ⋯ Maintaining physiological targets in several areas remains part of protocol led care in the acute phase of TBI management. As evidence accumulates however, the target values and therefore therapies may be set to change.
-
As the increased use of new oral anticoagulants may put patients at particular risk of bleeding, experts suggested strategies to perform neuraxial anesthesia as well tolerated as possible. This review summarizes different approaches. ⋯ A simplified approach covering recent recommendations is given which may aid well tolerated use of neuraxial blocks in patients taking new oral anticoagulants.
-
Effective analgesia is necessary for optimal recovery after surgery, but children often do not attain adequate postoperative pain control. This review examines the current trends in paediatric regional anaesthesia. ⋯ By using a multimodal approach that includes regional anaesthesia, paediatric pain management should aim to reduce patients' pain to an acceptable level without compromising their degree of mobilization. Undoubtedly, peripheral nerve blocks improve analgesia, but future large prospective studies should be conducted to further delineate their effectiveness, duration and safety.
-
Curr Opin Anaesthesiol · Oct 2015
ReviewBreakthrough pain in cancer patients: prevalence, mechanisms and treatment options.
The aim of this article was to examine the definition, the characteristics, and the management of breakthrough cancer pain (BTP) in cancer patients by a critical review of recent literature. ⋯ BTP represents a serious problem reported by many cancer patients despite receiving regular use of opioids. Subgroups of breakthrough pain have been identified. Different modalities of pharmacological interventions are available. Further studies are warranted to assess the net benefit of these drugs to assist decision-making by patients, clinicians, and payers according to individual clinical conditions.