Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2009
ReviewMultimodal analgesia for controlling acute postoperative pain.
Multimodal analgesia is needed for acute postoperative pain management due to adverse effects of opioid analgesics, which can impede recovery; a problem that is of increasing concern with the rapid increase in the number of ambulatory surgeries. Yet, the literature on multimodal analgesia often shows variable degrees of success, even with studies utilizing the same adjuvant medication. ⋯ There is a continuing need to explore new drug combinations to achieve all of the purported goals of multimodal anesthesia.
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In this review we focus on recent findings in the anesthetic management of patients undergoing craniotomy while awake, and propose a structured approach to the clinical practice of 'anesthesia' for awake neurosurgery. ⋯ Although anesthesia for awake craniotomy is usually a well tolerated procedure it requires an extensive knowledge of the principles underlying neuroanesthesia and of specific technical strategies including local anesthesia for scalp blockade, advanced airway management, dedicated sedation protocols, and skillful management of hemodynamics.
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Worldwide, the number of overweight and obese patients has increased dramatically. As a result, anesthesiologists routinely encounter obese patients daily in their clinical practice. The use of regional anesthesia is becoming increasingly popular for these patients. When appropriate, a regional anesthetic offers advantages and should be considered in the anesthetic management plan of obese patients. The following is a review of regional anesthesia in obesity, with special consideration of the unique challenges presented to the anesthesiologist by the obese patient. ⋯ Successful peripheral and neuraxial blockade in obese patients requires an anesthesiologist experienced in regional techniques, and one with the knowledge of the physiologic and pharmacologic differences that are unique to the obese patient.
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Curr Opin Anaesthesiol · Oct 2009
ReviewParavertebral block: cervical, thoracic, lumbar, and sacral.
This article outlines the new developments around all four types of paravertebral block: cervical, thoracic, lumbar, and sacral. ⋯ We discuss commonality and differences between the four types of paravertebral blocks, and newer indications and concerns, especially pertaining to nerve microanatomical differences, are highlighted.
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Curr Opin Anaesthesiol · Oct 2009
ReviewRole of N-methyl-D-aspartate receptor antagonists in postoperative pain management.
In recent years, hundreds of studies have examined the clinical efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine and dextromethorphan as an adjunct to routine postoperative pain management. The purpose of this review is to describe the detail of the study that successfully demonstrated the efficacy of NMDA receptor antagonists. ⋯ The co-administration of ketamine and morphine as a mixture is not recommended for postoperative pain relief. As an adjunct in multimodal analgesia, low-dose ketamine infusion and the administration of dextromethorphan may be able to improve postoperative pain status. Memantine exhibits the greatest potency among NMDA receptor antagonists. In future, research should consider the perioperative infusion of ketamine followed by long-term administration of memantine for the prevention of persistent pain.