Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2016
ReviewNew modalities of neurostimulation: high frequency and dorsal root ganglion.
Neurostimulation is a well tolerated, cost-efficient, and effective method to treat chronic pain. Although spinal cord stimulation (SCS) has been shown to help patients, newer modalities such as burst, kilohertz-frequency, and dorsal root ganglion stimulation may provide greater pain relief, fewer paresthesias, and better outcomes. ⋯ Improvements in pain control and patient satisfaction suggest that these new stimulation patterns will greatly increase the utility of neurostimulation; however, clinical trials with broader patient populations have to be done to support more extensive use of these therapies.
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Curr Opin Anaesthesiol · Oct 2016
ReviewIntraoperative neurophysiologic monitoring: utility and anesthetic implications.
Intraoperative neurophysiologic monitoring (IONM) has been rapidly adopted as a standard monitoring technique for a growing number of surgical procedures. This article offers a basic review of IONM and discusses some of its latest applications and anesthetic techniques that optimize monitoring conditions. ⋯ IONM is commonly used in a growing number and variety of surgical procedures, and has been shown to improve outcomes. IONM poses challenges for the anesthesiologist, but tailoring the anesthetic to be compatible with the monitoring techniques in use can help to prevent surgical complications.
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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 The see one, do one, teach one approach is obsolete and should be abandoned.
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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
ReviewUltrasound indications for chronic pain management: an update on the most recent evidence.
The ability of ultrasound to provide detailed anatomic visualization while avoiding radiation exposure continues to make it an appealing tool for many practitioners of chronic pain management. This review will present the most recent evidence regarding the use of ultrasound-guidance for the performance of interventional procedures in the treatment of chronic pain. ⋯ Despite continued interest in ultrasound-guided techniques for chronic pain management procedures, the evidence is still limited mainly to small, randomized trials and case series. For some procedures, such as stellate ganglion block and peripheral joint injections, recent evidence appears to be tilting in favor of ultrasound-guidance as the preferred technique, though fluoroscopy continues to be a much more reliable method for detection of intravascular uptake of injectate.