Anesthesiology clinics
-
Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. ⋯ Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.
-
Anesthesiology clinics · Dec 2007
ReviewInvasive and minimally invasive surgical techniques for back pain conditions.
This article summarizes current issues related to invasive and minimally invasive surgical techniques for back pain conditions. It describes pain generators and explains theories about how discs fail. ⋯ Problems related to current imaging are also presented. The article concludes with a discussion about physical therapy.
-
Anesthesiology clinics · Sep 2007
ReviewAnesthesia for endovascular neurosurgery and interventional neuroradiology.
This review outlines the roles of anesthesiologists in the management of patients undergoing invasive endovascular procedures to treat vascular diseases, primarily of the central nervous system. This practice usually is termed interventional neuroradiology or endovascular neurosurgery. The discussion emphasizes perioperative and anesthetic management strategies to prevent complications and minimize their effects if they occur. Planning anesthetic and perioperative management is predicated on understanding the goals of the therapeutic intervention and anticipating potential problems.
-
Perhaps the greatest recent controversy in the medical management of complex neurologic and neurosurgical patients has been the defining of the optimal care arena. Despite some early skepticism and measured recognition by the ICU community, neurosciences critical care has grown into a well-recognized subspecialty. Within this environment, the diverse expertise of surgeons, neurologists, and anesthesiologists come together to define best therapeutic strategies. Two neurologic disease states that, in particular, continue to elicit expansive interdisciplinary debate are spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage.
-
Transcranial perfusion monitoring provides early warning of impending brain ischemia and may be used to guide management of cerebral perfusion and oxygenation. The monitoring options include measurement of intracranial and cerebral perfusion pressures, assessment of cerebral blood flow, and assessment of the adequacy of perfusion by measurement of cerebral oxygenation and brain tissue biochemistry. Some monitoring techniques are well established, whereas others are relatively new to the clinical arena and their indications are still being evaluated. Currently available monitoring techniques are reviewed and their appropriateness and application to the perioperative period is discussed.