Current opinion in anaesthesiology
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The debate continues as to whether regional anesthesia is safer than general anesthesia. However, the choice of anesthetic technique is a complex decision. This review of the most recent publications compares the safety of regional anesthesia with that of general anesthesia.
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Since the first report of alpha2-adrenoceptor agonists, the list of clinical indications for this class of drugs continues to expand. Alpha2-adrenoceptor agonists have several beneficial actions during the perioperative period. ⋯ Furthermore, alpha2-adrenoceptor agonists may offer benefits in the prophylaxis and treatment of perioperative myocardial ischaemia and their role in pain management and regional anaesthesia is increasing. The development of new, highly selective compounds which not only reduce anaesthetic requirements but induce anaesthesia by themselves may provide a new concept for the administration of anaesthesia.
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Tramadol is a unique analgesic offering moderate, dose-related pain relief through its action at multiple sites. In contrast to pure opioid agonists, it has a low risk of respiratory depression, tolerance and dependence. ⋯ It may have advantages in paediatric and day-case surgery and as an adjunct in local anaesthetic techniques. This review provides an evidence-based account of the role of tramadol in modern practice.
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Curr Opin Anaesthesiol · Jun 2000
Patient-controlled epidural analgesia or continuous infusion: advantages and disadvantages of different modes of delivering epidural analgesia for labour.
Patient-controlled epidural analgesia, intermittent top-up and continuous infusion are equally effective in providing epidural pain relief during labour. Patient-controlled epidural analgesia is associated with a significant reduction in hourly dose requirements when compared with continuous infusion, and by transferring the responsibility for epidural top-up, it offers the parturient the psychological benefit of being in control. ⋯ However, the safety of the method needs to be documented more extensively, and the advantage of a reduction in hourly dose requirements needs to be visualized in terms of an improvement in labour or neonatal outcome. Moreover, the optimal dose, drug combination and settings still remain to be determined.