Current opinion in anaesthesiology
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Gender differences are well known in clinical pain and pain-related diseases. However, studies analyzing gender differences in postoperative pain yielded inconsistent finding. The aim of this review was to summarize recent findings on this matter. ⋯ Women seem to be at higher risk to develop severe postoperative pain but gender differences seem to be small and of low clinical relevance. We argue that major confounders may explain discrepancies between studies. Large prospective studies and registry data assessing gender aspects including confounders need to be done in the future.
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Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology. ⋯ DBS is a robust surgical treatment for a variety of neurological disorders. Appropriate anaesthetic agents that achieve patient comfort without interfering with electrophysiology are paramount.
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Monitoring and therapy of patients in neurocritical care are areas of intensive research and the current evidence needs further confirmation. ⋯ Although strong evidence is lacking, multimodal monitoring is of great value in neurocritical care patients and may help to provide patients with the optimal therapy based on the individual pathophysiological changes.
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Effective analgesia is necessary for optimal recovery after surgery, but children often do not attain adequate postoperative pain control. This review examines the current trends in paediatric regional anaesthesia. ⋯ By using a multimodal approach that includes regional anaesthesia, paediatric pain management should aim to reduce patients' pain to an acceptable level without compromising their degree of mobilization. Undoubtedly, peripheral nerve blocks improve analgesia, but future large prospective studies should be conducted to further delineate their effectiveness, duration and safety.