International anesthesiology clinics
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Int Anesthesiol Clin · Jan 2012
ReviewRegional anesthesia procedures for shoulder and upper arm surgery upper extremity update--2005 to present.
This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. ⋯ Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined perineural analgesic adjuvants prolong low-concentration LA nerve blocks sufficiently to render brachial plexus catheters as unnecessary would certainly represent another quantum leap.
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Int Anesthesiol Clin · Jan 2012
ReviewThe role of extracorporeal membrane oxygenation (ECMO) therapy in acute heart failure.
ECMO is a reliable and useful treatment for patient with acute cardiac failure. However, outcomes of cardiac ECMO are not yet as successful as case of ECMO support for respiratory failure. ⋯ Other options, including LVADs and heart transplant, should be considered when patients do not show any improvements under ECMO therapy. A multidisciplinary approach is required to provide the maximum chance of survival after ECMO treatment.
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PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice.
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Int Anesthesiol Clin · Jan 2012
Special considerations and recommendations for interventions for pediatric chronic pain.
In select cases, interventional pain management techniques can bean effective adjunct to the multidisciplinary care of pediatric patients with chronic pain. The secret to success stems in proper patient selection and in delineating clear goals and expectations—motivated patients do well. Comfort measures ranging from distraction through general anesthesia should be employed to alleviate anxiety and distress, and to provide optimal working conditions for the proceduralist. In the appropriate context, the occasion to provide interventional care can be a rewarding role for the anesthesiologist to play in chronic pediatric pain patient care.