Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2023
ReviewSpine surgery under neuraxial vs. general anesthesia: the current state of comparative outcomes research.
The impact of primary anesthetic technique on outcomes after spine surgery is controversial. Given frequent calls for well designed prospective comparative studies of neuraxial anesthesia vs. general anesthesia and recent reports of 'awake spine surgery' successes in the surgical literature, an updated evidence review is indicated. ⋯ Our understanding of the risks, benefits and comparative outcomes between neuraxial anesthesia and general anesthesia for spine surgery is evolving. Although the results derived from this body of literature suggest specific benefits of neuraxial anesthesia, further research is required before widespread recommendations for either technique can be made. Until then, both neuraxial anesthesia and general anesthesia are reasonable choices for lumbar spine surgery of short duration, in appropriately selected patients.
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Curr Opin Anaesthesiol · Oct 2023
ReviewInnovations in diagnostic and treatment options for pediatric epilepsy and their anesthetic implications.
To provide an overview of anesthetic techniques for innovative diagnostic and therapeutic epilepsy procedures performed on pediatric patients. ⋯ The number of diagnostic and treatment options being used for the management of pediatric epilepsy has increased significantly. In the past few years, a handful of articles have been published, which describe the anesthetic considerations for these procedures. These studies are helpful to anesthesiologists who are planning an upcoming anesthetic or who are developing a 'best practice' model for their institution. Because unlike other diagnostic studies, failure to understand what effects anesthetics have on the brain, may negate the utility of the study. Although these new findings can be used to provide some anesthesia practice recommendations for epilepsy procedures in which the best management is still unclear, additional high-quality studies are needed.
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Curr Opin Anaesthesiol · Oct 2023
ReviewComparative review of airway anesthesia and sedation methods for awake intubation.
Successful awake intubation hinges upon adequate airway anesthesia and sedation for patient comfort. This review will summarize relevant anatomy and regional anesthesia techniques to achieve airway anesthesia, and compare various airway anesthesia and sedation regimens. ⋯ Emerging evidence has indicated that nerve blocks for airway anesthesia may be superior to other methods of topicalization. Additionally, dexmedetomidine can be useful, both as monotherapy and with supplemental sedatives, to safely provide anxiolysis for the patient and increase success. However, it is crucial to note that the method of airway anesthesia and sedation regimen should be adapted to each patient and clinical situation, and knowledge of multiple techniques and sedation regimens can best equip anesthesiologists to do so.
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Curr Opin Anaesthesiol · Oct 2023
Review Meta AnalysisEtiology, management, and sequela of postdural puncture headache.
The purpose of this article is to provide readers with a concise overview of the cause, incidence, treatment of, and sequalae of postdural puncture headaches (PDPH). Over the past 2 years, much data has been published on modifiable risk factors for PDPH, treatments for PDPH, and sequalae of PDPH particularly long-term. ⋯ Emerging evidence demonstrates that in patients who are at low risk of PDPH, needle type and gauge may be of no consequence in a patient developing a PDPH. Although epidural blood patch (EBP) remains the gold-standard of therapy, several other interventions, both medical and procedural, show promise and may obviate the need for EBP in patients with mild-moderate PDPH. Patients who endure dural puncture, especially accidental dural puncture (ADP) are at low but significant risk of developing short term issues as well as chronic pain symptoms.
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Curr Opin Anaesthesiol · Oct 2023
ReviewContinuous peripheral nerve blocks for analgesia following painful ambulatory surgery: a review with focus on recent developments in infusion technology.
Continuous peripheral nerve blocks (cPNB) decrease pain scores and opioid consumption while improving patient satisfaction following ambulatory surgery. This review focuses on the history and evolution of ambulatory cPNBs, recent developments in infusion technology that may prolong the duration of analgesia, optimal choice of cPNB for various surgical procedures, and novel analgesic modalities that may prove to be alternatives or supplements to cPNBs. ⋯ Patients undergoing painful ambulatory surgery are likely to have less pain and require fewer opioid analgesics when receiving a cPNB for postoperative analgesia. Advances in electronic pumps used for cPNBs may increase the duration of these benefits.