Current opinion in anaesthesiology
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The use of ultrasound for peripheral nerve blockade is becoming popular. Although the feasibility of ultrasound-guided nerve blockade is now clear, it is uncertain at this time whether it represents the new standard for regional anesthesia in terms of efficacy and safety. ⋯ Ultrasound is a valuable tool that is now available to the regional anesthesiologist, and it is fast becoming a standard part of practice. It promises to be of especial value to the less experienced practitioner. Ultrasound does not in itself, however, guarantee the efficacy and safety of peripheral nerve blockade. Proper training in its use is required and we can expect to see the development of formal standards and guidelines in this regard.
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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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Curr Opin Anaesthesiol · Oct 2008
ReviewTranscranial Doppler ultrasonography: a diagnostic tool of increasing utility.
Since its introduction in 1982, transcranial Doppler ultrasonography has become an important diagnostic and monitoring tool in patients with surgical disease. It has applications in the perioperative period, as well as in the intensive care unit. It is therefore appropriate for the anesthesiologist to maintain an understanding of its current utility. ⋯ Although there are several settings in which transcranial Doppler has well established usefulness, there are many more in which it is likely valuable, such as traumatic brain injury, ischemic stroke, and fulminant hepatic failure. Further research is needed in these fields to elucidate the exact role for transcranial Doppler.
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The present review highlights new insights into indications and guidance during procedures for continuous peripheral nerve blocks. ⋯ Continuous peripheral nerve blocks are essential in the perioperative anesthetic management of in-hospital or ambulatory patients. Ultrasound guidance and stimulating catheters can help anesthetists during the procedure.