Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Oct 2008
ReviewThe role of tetrastarches for volume replacement in the perioperative setting.
Current opinion in perioperative fluid therapy suggests that the use of colloids to achieve haemodynamic optimization may result in improved clinical outcomes. This has focused interest on the colloid solutions, particularly on the newest of these, the tetrastarches. This review will address the advantages and disadvantages of the starch solutions with particular emphasis on the advantages offered by the tetrastarches, as these products, which have been widely used in Europe for a number of years, have recently been released in the United States. ⋯ Tetrastarch represents a substantial advance in colloid therapy, offering good volume effectiveness with a very low risk of adverse effects.
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Acute neuropathic pain (ANP) is a condition that is under-recognized, often difficult to treat and one that may progress to persistent pain and disability. This review examines the diagnosis and treatment in order to assist clinicians in providing better care to patients with this debilitating pain. ⋯ The diagnosis of ANP is assisted by knowledge of the medical circumstances that have a higher risk of the condition developing, a detailed pain history with a directed examination and use of neuropathic pain scales. Although the data are lacking, agents that have demonstrated efficacy in persistent neuropathic pain states should be used in ANP. Refractory ANP could be treated with either intravenous lidocaine or calcitonin. Future research should be directed at validating a scale of neuropathic pain in ANP and conducting more therapeutic trials.
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Curr Opin Anaesthesiol · Oct 2008
ReviewAnesthesia for functional neurosurgery: the role of dexmedetomidine.
The purpose of this review is to summarize current approaches to the anesthetic management of functional neurosurgery and to describe the application of an alpha-2-adrenergic agonist dexmedetomidine in the anesthetic management of functional neurosurgical procedures. ⋯ Dexmedetomidine has been demonstrated to provide a successful sedation without impairment of electrophysiologic monitoring in functional neurosurgery. Prospective randomized studies are warranted to delineate an optimal regimen of dexmedetomidine sedation and any dose-related influence on neurophysiologic function.
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Curr Opin Anaesthesiol · Oct 2008
ReviewContinuous peripheral nerve blockade for postoperative analgesia.
To review the recent literature involving the use of continuous peripheral nerve sheath catheters in the management of postoperative pain. ⋯ Continuous peripheral nerve blocks are an excellent additional modality to compliment other multimodal analgesics to control moderate to severe postoperative pain.
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Clinical and experimental data suggest that hypergylcaemia lowers the ischaemic neuronal threshold and worsens outcome in the presence of neurological injury from trauma, stroke and subarachnoid haemorrhage. This review aims to appraise the evidence for tight glycaemic control in patients with neurological injury. ⋯ Clinical and experimental data suggest that hyperglycaemia lowers the ischaemic neuronal threshold in the presence of neurological injury. Tight glycaemic control may result in hypoglycaemia, which in itself can be detrimental. Therefore, it seems sensible that we should accept slightly less tight blood glucose control than in the critically ill patient without neurological injury.