Anesthesiology clinics
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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.
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This article concentrates on recent evidence about opioid analgesics for persistent noncancer pain. Evidence confirms that opioids are drugs with a definite risk of adverse events. ⋯ Strong opioids should be reserved for patients who fail to respond to other lower-risk options and only after proper consideration is given to the long-term consequences of strong opioid use. Problems associated with opioids dictate that more efficacious and safer drugs need to be found.
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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.
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Anesthesiology clinics · Sep 2007
ReviewPerioperative pain management in the neurosurgical patient.
The perioperative management of pain in neurosurgical patients is a controversial topic with management decisions based mainly on reports of anecdotal experiences. There is no consensus regarding the standardization of pain control in this patient population. ⋯ This article provides information about the various techniques and approaches, based on the latest research and clinical trials conducted in this patient population. Specifically, the physiology of pain in patients undergoing brain or spine surgery, the different modalities for pain control, and the diverse choice of drugs, with their associated risks and benefits, are reviewed.
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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.