Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2016
ReviewSafety and efficiency of dexmedetomidine as adjuvant to local anesthetics.
To review the current knowledge of dexmedetomidine as an additive drug to local anesthetics in peripheral and neuraxial regional anesthesia. ⋯ Dexmedetomidine has a potency to ameliorate pharmacodynamic characteristics of peripheral and neuraxial regional anesthetic techniques and is therefore currently the most promising additive drug in regional anesthesia. Future scientific efforts should focus on dose finding studies for particular regional anesthetic techniques. Approval of dexmedetomidine for regional anesthetic indications should be the final target.
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Curr Opin Anaesthesiol · Oct 2016
ReviewAnaesthesia for neuroradiology: thrombectomy: 'one small step for man, one giant leap for anaesthesia'.
Endovascular management of acute thrombotic strokes is a new management technique. Anaesthesia will play a key role in the management of these patients. To date there is no established method of managing these patients from an anaesthetic perspective. ⋯ There is a paucity of robust evidence for the best anaesthetic practice in this cohort of patients. Airway protection seems to be an issue in 2.5% of cases. Timing of the procedure is vital, and any delay may be detrimental to neurological outcome. In a survey of neurointerventionalists, the main concern they expressed was the potential delay to revascularization posed by anaesthesia. Patients complain of pain during mechanical clot retrieval if awake. The overall consensus seems to be favouring conscious sedation over general anaesthesia in the acute setting.
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Curr Opin Anaesthesiol · Oct 2016
ReviewTeaching concepts in ultrasound-guided regional anesthesia.
Ultrasound-guided regional anesthesia is a challenging, complex skill and requires competence in teaching. The aim of this study was to review current literature on identification of education and learning of ultrasound-guided regional anesthesia and to summarize recent findings on teaching concepts. ⋯ Although a lot of key questions cannot be answered by the latest study results, some interesting findings were able to improve existing education programs. These results should be tailored to the individual need of a trainee, and the effects of improved training programs on patient safety and quality of care have to be investigated. The see one, do one, teach one approach is obsolete and should be abandoned.
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The aim of the review is to examine the possible benefit of regional anaesthesia in four areas of perioperative care. These are: the relationship between anaesthesia and cancer recurrence; the effects of regional anaesthesia in orthopaedic surgery; its use in people with obstructive sleep apnoea syndrome; and its potential for preventing chronic postsurgical pain. ⋯ There is at present little unequivocal, high-quality evidence to confirm clear superiority of regional anaesthesia over general anaesthesia for any of the conditions described in this article. Perhaps as important as the choice of technique is the practitioner's skill and attention to detail; in addition, the major contributor to perioperative risk remains the patient and his/her pre-existing condition.