Current opinion in anaesthesiology
-
The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. ⋯ Following a great deal of progress in anesthetic management, awake craniotomy, which had been a relatively rare approach, is now a commonly performed procedure for neurosurgical intervention. Modern anesthesia techniques can provide for successful brain mapping in almost any patient. Management of awake craniotomy in high-risk patients is a central task for future research.
-
Curr Opin Anaesthesiol · Oct 2018
ReviewFluid management concepts for severe neurological illness: an overview.
The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. ⋯ As the possibility grows closer that we can monitor the physiological parameters with direct relevance for neurological outcomes and the various complications associated with neurocritical illness, we may finally move away from static therapy recommendations, and toward individualized, precise therapy. Although we believe therapy should ultimately be individualized rather than standardized, it is clear that the monitoring tools and analytical methods used ought to be standardized to facilitate appropriately powered, prospective clinical outcome trials.
-
Curr Opin Anaesthesiol · Oct 2018
ReviewIntraoperative neurophysiological monitoring in neuroanesthesia.
The purpose of this review is to highlight the importance of making informed choices of anesthetics and evaluating the impact of depth of anesthesia, hemodynamic status and other factors capable of interfering with signal capture during intraoperative neurophysiological monitoring (IONM). ⋯ Experience with IONM, the use of an adequate IONM modality, and knowledge of the effect of anesthetic techniques and agents on neurophysiological parameters are fundamental for reliable measurements. The current gold standard in IONM is total intravenous anesthesia without neuromuscular block.
-
This narrative review describes the current framework for informed consent discussions for regional anesthesia practice from an ethical and medicolegal stand point as the cornerstone of the patient-physician relationship and the respect for patient autonomy. Recent guidelines and position statements from anesthesia societies have emphasized the importance of these discussions and their appropriate documentation. ⋯ Defining the material risks of ultrasound-guided regional anesthetic procedures remains challenging, due in part to the difficulty in quantifying incidence rates of relatively rare events. However, well informed discussions are of great importance to support patient autonomy and lay a strong foundation for the patient-anesthesiologist relationship.
-
Curr Opin Anaesthesiol · Oct 2018
ReviewExtended release bupivacaine formulations for postoperative analgesia: an update.
New formulations of local anesthetics with sustained release and longer duration of action are being developed to improve patient outcomes following surgery. This review summarizes the efficacy and safety of the three most recently developed extended-release formulations of the local anesthetic, bupivacaine. ⋯ Extended-release bupivacaine formulations are promising alternatives to prolong duration of analgesia. To date, only EXPAREL has been approved by the FDA for tissue infiltration during surgery and for interscalene nerve block.