Current opinion in anaesthesiology
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Evidence from retrospective studies suggests that regional anesthesia reduces the risks of major complications associated with carotid endarterectomy compared with general anesthesia, namely: stroke, stroke/death, death and myocardial infarction. ⋯ The anesthesiologist should learn how to place a superficial cervical plexus block. The technique is easy to master, effective and carries a low risk of inducing a serious complication.
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Curr Opin Anaesthesiol · Oct 2008
ReviewDifferences between and combinations of opioids re-visited.
Recent studies highlighting between-opioid differences in patient outcomes, opioid receptor interactions and animal study findings implicating a 'fine control' mechanism underpinning potential diversity in opioid receptor signalling that could potentially be exploited to develop novel opioid analgesics with improved tolerability are reviewed. ⋯ Enhanced understanding of diversity in opioid signalling has the potential to produce novel strong opioid analgesics with improved tolerability.
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Patients undergoing major vascular surgery are at increased risk for postoperative complications due to the high incidence of comorbidities in this population.Epidural anaesthesia provides potential benefits but its effect on morbidity and mortality is unclear. ⋯ Optimization of perioperative care rather than the anaesthetic technique may have potential benefit in improving postoperative outcome.
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This review will highlight the recent functional magnetic resonance imaging, positron emission tomogram scan and connectivity studies in anesthesia and analgesia. ⋯ Slowly, a pattern of neuronal activity reflecting hypnosis, analgesia, amnesia and reflex suppression seems to be emerging giving us a better insight into the central nervous system effects of anesthesia.
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Curr Opin Anaesthesiol · Oct 2008
Review Comparative StudySaline versus balanced hydroxyethyl starch: does it matter?
A total balanced volume replacement strategy is a new concept for correcting hypovolemia. To fulfill this concept, balanced colloids, for example, balanced hydroxyethyl starch (HES) solutions, are necessary in addition to balanced crystalloids. Conventional HES solutions consist of saline with abnormally high concentrations of sodium (154 mmol/l) and chloride (154 mmol/l). ⋯ Although only a few studies using balanced HES solutions are available at present, it is difficult to argue against using HES preparations that are adapted to plasma instead of HES preparations that contain unphysiologic saline solution. First results are very promising - large clinical trials are necessary to assess the value of a total balanced volume replacement strategy including plasma-adapted HES solutions.