Current opinion in anaesthesiology
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Connectivity is a technique that uses functional MRI (fMRI) to explore global brain function in healthy and diseased states. Connectivity is now being studied as a part of global brain function in major national and international studies. It is, therefore, timely to review its relevance to anaesthesia. ⋯ Higher mental function related networks such as the DMN, the executive control network and salience are more sensitive to anaesthesia. In geriatric patients, the DMN is impaired, which affects cognition. Hence, the combined effect of age and anaesthesia in elderly on mental function can cause significant postoperative cognitive impairment.
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Increased 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. This review addresses the many systemic complications of TBI that make achieving these targets challenging and can influence outcome. ⋯ Effective management of TBI should go beyond formulaic-based pursuit of physiological targets and requires a detailed understanding of the multisystem response of the body.
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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.
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Monitoring and therapy of patients in neurocritical care are areas of intensive research and the current evidence needs further confirmation. ⋯ Although strong evidence is lacking, multimodal monitoring is of great value in neurocritical care patients and may help to provide patients with the optimal therapy based on the individual pathophysiological changes.
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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.