Current opinion in anaesthesiology
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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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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.
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The review aims to present the latest research into microglia and their role in pain. ⋯ Glial cells, composed of microglia, astrocytes, and oligodendrocytes, outnumber neurons in the central nervous system. The crosstalk between these cells and neurons is now established as participating in the development of chronic pain. There has been a great advance in the description of microglia reactivity from pro to anti-inflammatory phenotypes. The modulation of these phenotypes could be a potential target for pain therapy. Recently, different microglial reactivity between man and woman and between neonates and adults, in response to nerve injury were described, which could explain some of the sex differences in pain sensitivity and the absence of neuropathic pain development in neonates. Clinical trials using microglia as a target have been carried out in various neurological diseases and pain, with limited efficacy in the latter, but there are nonetheless, indications that with some improvement in study strategies microglia could be a future target for pain control.
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The study focuses on neural blocks with local anesthetics in postoperative and chronic pain. It is prompted by the recent publication of several systematic reviews and guidelines. ⋯ Recent literature strongly supports the use of regional anesthesia for postoperative pain, whereby infusions at peripheral nerves and surgical site are gaining increasing importance. Local anesthetic blocks are valid for the diagnosis of facet joint pain and effective in treating headache. There is a need for further research in diagnostic and therapeutic blocks for chronic pain.
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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.