Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2006
ReviewPostcesarean analgesia: effective strategies and association with chronic pain.
The management of postoperative pain after cesarean section slightly differs from that of the general surgical population, specifically women need to recover quickly to take care of their newborn baby. Optimal pain management is imperative for the success of immediate-term and long-term rehabilitation and this principle applies to obstetric patients. There is growing evidence that perioperative pain management has consequences extending well beyond the immediate recovery period. Unrelieved postoperative pain is a striking risk factor for the development of residual pain. ⋯ The use of balanced analgesia has significantly improved acute pain management after cesarean section. Future studies should extend their investigations beyond the first 48 h and consider the long-term effects of different analgesic regimens, that is, those that alter the development of residual pain.
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With the graying of the Western population, there is a continuous increase in the proportion of elderly patients undergoing surgical procedures. Geriatric anesthesia is emerging from a 'subspecialty' to the mainstream of today's anesthesia and perioperative care. Much has been written on anesthesia for the elderly, but this review will concentrate on selected topics related to elderly care that represent current unresolved and pertinent issues for the care of the elderly surgical patient. ⋯ Although age is a clear risk factor for postoperative cognitive dysfunction, the association of general anesthesia with cognitive dysfunction is less clear, as is the effect of anesthesia per se or surgery on long-term cognitive dysfunction. Cardiac diastolic dysfunction is a relatively new and evolving concept in anesthesia and perioperative medicine, yet clearly diastolic dysfunction even with a normal ejection fraction may have a significant effect on the perioperative outcome and management of elderly patients. Small, but powerful studies have shown significant outcome benefit with prophylactic perioperative beta-blockade in high-risk patients undergoing major noncardiac surgery. Data from other studies, however, are still conflicting and the final verdict awaits larger scale outcome studies.
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Curr Opin Anaesthesiol · Jun 2006
ReviewImaging techniques for regional nerve blockade and vascular cannulation in children.
Many regional anaesthesia techniques as well as central venous access in paediatric patients are still described insufficiently. This review article describes the basics in small part ultrasonography and highlights new developments in ultrasonographic-guided regional anaesthetic techniques and vascular access. ⋯ Regional anaesthesia and vascular access under ultrasonographic guidance offers significant advantages and improved safety. Additional education and hand skills, extensive experience and adequate equipment are necessary for the effective implementation of these methods in the daily clinical practice.
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Curr Opin Anaesthesiol · Jun 2006
ReviewThe use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics.
Neuraxial adjuvant drugs are used to improve analgesia and to decrease complications associated with a high dose of a single drug. Opioids are used in routinely, but alpha2-agonists, such as clonidine or cholinesterase inhibitors (neostigmine), have also been used for labour analgesia or to relieve pain following caesarean section. Both drugs possess a common mechanism of action that can be beneficial. ⋯ Co-administration of neuraxial drugs may enhance analgesia and reduce the side effects of each drug. Clonidine and neostigmine may be used in obstetrics, under some conditions.
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Curr Opin Anaesthesiol · Jun 2006
ReviewRecent developments in the perioperative fluid management for the paediatric patient.
Maintenance fluid therapy represents the volume of fluids and amount of electrolytes and glucose needed to replace anticipated physiological losses from breath, sweat and urine and to prevent hypoglycaemia. For 50 years, this therapy was based on Holliday and Segar's formula, which proposed to match children's water and electrolyte requirements on a weight-based calculation using hypotonic solutions. Recent publications highlight the risk of hyponatraemia in the postoperative period and the facilitating role of a hypotonic infusion, leading some people to recommend replacing hypotonic with isotonic solutions. ⋯ As free water excretion is altered for all children in the postoperative period, it is necessary to reduce the volume of maintenance fluid therapy to half the previously recommended volume. The choice of an isotonic solution should be more pertinent to that of a hypotonic solution, but evidence is lacking for a definitive answer.