Current opinion in anaesthesiology
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New block techniques are being constantly developed or old techniques modified to improve outcomes after surgery. This review discusses the reasons why new block techniques need to be developed to match the needs of contemporary anesthetic practice. ⋯ Future studies need to be undertaken to further refine these techniques and produce evidence of support for analgesic efficacy, safety, and reliability.
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Curr Opin Anaesthesiol · Oct 2018
ReviewThe road to accreditation for fellowship training in regional anesthesiology and acute pain medicine.
The purpose of this review is to provide the background and rationale for pursuing accreditation of regional anesthesiology and acute pain medicine (RAAPM) fellowships, explain specific steps and challenges in the process, and forecast the future of fellowship training. ⋯ Programs with initial ACGME accreditation are on a 2-year term and will be reviewed to evaluate adherence to the program requirements and the quality of fellowship training. Deficiencies identified will need to be resolved or face loss of accreditation. However, a program's maintenance of accreditation represents a commitment to its fellows to provide a training experience that can be held as a benchmark for all programs.
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Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated. ⋯ The current practice of anesthesia for ECT should not be modified, as the evidence of studies is either too low or the results are inconsistent. Some approaches are promising but require validation in further studies with a higher number of participants.
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Curr Opin Anaesthesiol · Oct 2018
ReviewRecent developments in ultrasound imaging for neuraxial blockade.
Recent research has shed further light on the place of ultrasound imaging in neuraxial blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. ⋯ Ultrasound imaging of the spine is a valuable technique that, while not indicated for routine use, should be part of the skillset of any practitioner that regularly performs lumbar and thoracic neuraxial blockade.
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Curr Opin Anaesthesiol · Oct 2018
ReviewMechanisms of acute and chronic pain after surgery: update from findings in experimental animal models.
Management of postoperative pain is still a major issue and relevant mechanisms need to be investigated. In preclinical research, substantial progress has been made, for example, by establishing specific rodent models of postoperative pain. By reviewing most recent preclinical studies in animals related to postoperative, incisional pain, we outline the currently available surgical-related pain models, discuss assessment methods for pain-relevant behavior and their shortcomings to reflect the clinical situation, delineate some novel clinical-relevant mechanisms for postoperative pain, and point toward future needs. ⋯ Pathophysiological mechanisms of pain after surgery are increasingly discovered, but utilization of pain behavior assays are only sparsely able to reflect clinical-relevant aspects of acute and chronic postoperative pain in patients.