Expert review of neurotherapeutics
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Expert Rev Neurother · May 2011
ReviewTranscutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain.
The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. ⋯ The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future.
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Expert Rev Neurother · May 2011
ReviewPediatric procedural sedation and analgesia outside the operating room: anticipating, avoiding and managing complications.
In the new millennium, there has been a huge surge in the numbers of procedures performed under sedation in pediatric patients outside the operating room. Traditionally, these were performed by anesthesiologists. ⋯ Multi-institutional databases have been set up to investigate the complications related to procedural sedation and lessons are being learned from the analysis of these data. This article reviews these data and describes strategies to prevent and manage common adverse events following procedural sedation in children outside the operating room.
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Expert Rev Neurother · May 2011
ReviewThe use of ketamine in complex regional pain syndrome: possible mechanisms.
Complex regional pain syndrome is a neuropathic pain syndrome that is characterized by: severe pain beyond the area of injury; autonomic dysregulation; neurogenic edema; movement disorder; and atrophy and dystrophy. Ketamine is an open-channel NMDA blocker that only acts on those receptors whose Mg(2+) block has been lifted. ⋯ Different protocols are utilized depending on the severity of illness. There have been no serious ketamine-induced complications from these protocols, owing to careful psychological screening and the liberal use of midazolam and lorazepam to counter any psychomimetic effects and clonidine to block possible 'Olney's' lesions.
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Pre-operative embolization is a routinely utilized therapeutic adjunct to the resection of hypervascular lesions of the head and neck. In particular, pre-operative cerebral angiography and tumor embolization has become standard practice at many centers in the management of select intracranial meningiomas. However, controversy remains regarding its specific indications and clinical utility. In this article, we examine the principles of meningioma embolization, emphasizing the indications, risks and benefits associated with its use in the pre-operative setting.