Current opinion in anaesthesiology
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The ongoing debate on the outcome benefits of regional anaesthesia and analgesia over general anaesthesia and systemic analgesia has led to a large number of recently published papers, in particular systematic reviews and meta-analyses that justify a review of the current status of the debate. ⋯ Although there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anaesthesia on outcome is not completely resolved, possibly because the data are often not procedure specific. In addition, however, it may be that our current literature cannot provide a definitive answer.
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Clinicians are actively looking for an effective brain protection technique. With pharmacologic agents, several phase III trials in stroke, severe traumatic brain injury, and post-cardiac arrest survivors have failed. Hence there is renewed interest in mild to moderate hypothermia for brain protection. Phase III clinical trials with hypothermia have been successful only in post-cardiac arrest survivors and neonatal hypoxic encephalopathy. This review focuses on the possible reasons for our inability to translate into positive clinical trials what is observed consistently in laboratory models. ⋯ Hypothermia can at present be recommended only for post-cardiac arrest survivors and in neonatal hypoxic encephalopathy.
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Curr Opin Anaesthesiol · Oct 2006
ReviewAntidepressants as local anesthetics: is there a place in regional anesthesia?
Antidepressants have multiple sites of action. Among these, the ability to inhibit sodium channels has led to the increased interest in their use as local anesthetics. The following review summarizes the results of recent studies on this topic. ⋯ Although antidepressants indeed act as potent local anesthetics, their use in the clinical setting cannot be recommended as of today due to extensive local tissue toxicity.
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Curr Opin Anaesthesiol · Oct 2006
ReviewWhy we still use intravenous drugs as the basic regimen for neurosurgical anaesthesia.
Evolution of neurosurgery mainly trends towards minimally invasive and functional procedures including endoscopies, small-size craniotomies, intraoperative imaging and stereotactic interventions. Consequently, new adjustments of anaesthesia should aim at providing brain relaxation, minimal interference with electrophysiological monitoring, rapid recovery, patients' cooperation during surgery and neuroprotection. ⋯ Although all the objectives of neurosurgical anaesthesia cannot be met by one single anaesthetic agent or technique, propofol-based intravenous anaesthesia appears as the first choice to challenge the evolution of neurosurgery in the third millennium.
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Much effort has been taken to prove that a treatment initiated before surgery is more effective in reducing postoperative pain compared with the same intervention started after surgery. Clinical studies failed to demonstrate major clinical benefits of preemptive analgesia, however, and the results of recent systemic reviews are equivocal. The present review will discuss recent clinical as well as experimental evidence of preemptive analgesia and examine the implications of a preventive postoperative pain treatment. ⋯ Extending a multimodal analgesic treatment into the postoperative period to prevent postoperative pain may be superior compared with preemptive analgesia. In the future, appropriate drug combinations, drug concentrations and duration of preventive strategies need to be determined to be most beneficial for the management of acute and chronic pain after surgery.