Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2010
ReviewIs nitrous oxide use appropriate in neurosurgical and neurologically at-risk patients?
To address controversial issues surrounding the use of nitrous oxide as a component of anesthesia in neurosurgical and neurologically at-risk patients. ⋯ Except in a few specific circumstances, there exists no conclusive evidence to support the dogmatic avoidance of nitrous oxide in neurosurgical patients.
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Curr Opin Anaesthesiol · Oct 2010
ReviewThe clinical (ir)relevance of opioid-induced immune suppression.
Opioid-induced immune suppression has been demonstrated in cell culture experiments and in animal models. This review examines whether opioids also increase the risk of infections in the perioperative setting or on the ICU. ⋯ In contrast to in-vitro studies and to animal models, conclusive evidence is currently lacking that opioids induce clinically relevant infectious complications in patients. However, these findings should be interpreted with great caution, as almost no adequately designed trials have been performed. Peripherally selective opioid receptor antagonists might be useful if opioid-induced immune suppression should prove to be clinically relevant.
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Curr Opin Anaesthesiol · Oct 2010
Review Case ReportsNondermatomal somatosensory deficits: overview of unexplainable negative sensory phenomena in chronic pain patients.
To review the literature and our current understanding of nondermatomal somatosensory deficits (NDSDs) associated with chronic pain in regards to their prevalence, assessment and clinical presentation, cause and pathophysiology, relationship with conversion disorder and psychological factors, as well as their treatment and prognosis. ⋯ NDSDs represent prevalent phenomena associated with chronic pain. Further, research is needed to elucidate their origin, response to treatment, and prevalence in the general population, primary care settings, and nonpain patients.
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Curr Opin Anaesthesiol · Oct 2010
ReviewConditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states.
There is a growing body of knowledge on pain modulation in various disease states. This article reviews the state of the art regarding the clinical relevance of pain inhibition as revealed by 'pain inhibits pain' test paradigms, trying to organize the clinically relevant data, and emphasizing the pathophysiology of pain. In line with recent experts' recommendations, the term conditioned pain modulation (CPM) will be used, replacing the previous terms 'diffuse noxious inhibitory control (DNIC)' or 'DNIC-like' effects. ⋯ Low CPM efficiency is associated with higher pain morbidity and vice versa. Further work is awaited on clarifying plasticity of CPM and its relevance to selection and efficacy of pain therapy.