Articles: anesthesia.
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Int J Obstet Anesth · Dec 2024
Review"This is how we do it" Maternal and fetal anesthetic management for fetoscopic myelomeningocele repairs: the Texas Children's Fetal Center protocol.
Prenatal repair of myelomeningocele (MMC) is associated with lower rates of hydrocephalus requiring ventriculoperitoneal shunt and improved motor function when compared with postnatal repair. Efforts aiming to develop less invasive surgical techniques to decrease the risk for the pregnant patient while achieving similar benefits for the fetus have led to the implementation of fetoscopic surgical techniques. While no ideal anesthetic technique for fetoscopic MMC repair has been demonstrated, we present our anesthetic approach for these repairs, including considerations for both the pregnant patient and the fetus. ⋯ Additional considerations for the fetus include monitoring, fetal resuscitation strategies, and the theoretical risk of anesthetic neurotoxicity. Postoperatively, we use a multi-modal, opioid sparing regimen for analgesia. As advances in fetal surgery aiming to minimize risk to the pregnant patient alter the surgical approach, maternal-fetal anesthesiologists must adapt and incorporate the unique considerations of fetoscopy into their anesthetic management.
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J Pain Palliat Care Pharmacother · Dec 2024
ReviewDeafferentation in Pain Medicine: A Narrative Review of Mechanisms and Management.
Deafferentation is an umbrella term that includes several clinical conditions. The exact mechanism is not yet known, and the different clinical conditions do not necessarily share common pathophysiology. It includes both non-painful and painful conditions, including cancer pain conditions. ⋯ This type of pain is typically opioid-nonresponsive, but some patients may benefit. Neuronal destructive procedures are indicated for brachial plexus avulsion injuries. Spinal cord stimulation, dorsal root entry zone rhizotomy, deep brain thalamic stimulation, and motor cortex stimulation have been suggested for the management of the complex clinical conditions under the umbrella of deafferentation.
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Prior meta-analyses have established the potential of intravenous ketamine in safeguarding against neurocognitive impairment, but the efficacy of intravenous esketamine for the prevention of perioperative neurocognitive disorders (PND) remains uncertain. The primary aim of this meta-analysis was to conduct a comprehensive evaluation of the effects of esketamine on PND in adult surgical patients undergoing general anesthesia. ⋯ The use of intravenous esketamine as an adjuvant in general anesthesia may represent a potentially beneficial strategy for reducing susceptibility to PND, with potential benefits for preventing POD and POCD. Furthermore, it can decrease intraoperative opioid consumption and alleviate postoperative pain intensity without increasing the incidence of PONV.
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Meta Analysis Comparative Study
Comparison of vasopressors for management of hypotension in high-risk caesarean section under neuraxial anesthesia: a systematic review and network meta-analysis.
Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation. ⋯ Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery.
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Review Practice Guideline
Intrathecal catheter placement after inadvertent dural puncture in the obstetric population: management for labour and operative delivery. Guidelines from the Obstetric Anaesthetists' Association.
Following inadvertent dural puncture, insertion of an intrathecal catheter can provide both excellent labour analgesia and be used if necessary for caesarean section, however IT catheters carry risks and complexities that anaesthetists must be aware of.
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