Best Practice & Research-Clinical Anaesthesiology最新文献

{"title":"Spinal anesthesia in ambulatory surgery","authors":"Ann-Kristin Schubert (MD) ,&nbsp;Thomas Wiesmann (Professor) ,&nbsp;Hinnerk Wulf (Professor) ,&nbsp;Hanns-Christian Dinges (MD)","doi":"10.1016/j.bpa.2023.04.002","DOIUrl":"10.1016/j.bpa.2023.04.002","url":null,"abstract":"<div><p><span>Spinal anesthesia is a safe alternative to </span>general anesthesia<span> but remains underrepresented in the ambulatory setting. Most concerns relate to low flexibility of spinal anesthesia duration and the management of urinary retention in the outpatient setting.</span></p><p><span>This review focuses on the characterization and safety of the local anesthetics that are available to adapt spinal anesthesia very flexibly to the needs of </span>ambulatory surgery.</p><p>Furthermore, recent studies on the management of postoperative urinary retention provide evidence for safe, but report wider discharge criteria and much lower hospital admission rates.</p><p>With the local anesthetics that have current approval for usage in spinal anesthesia, most requirements for ambulatory surgeries can be met. The reported evidence on local anesthetics without approval supports clinically established off-label use and can improve the results even further.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 109-121"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of adverse effects of intrathecal opioids in acute pain","authors":"Sina Grape (Lecturer) ,&nbsp;Kariem El-Boghdadly (Consultant, Honorary Senior Lecturer) ,&nbsp;Eric Albrecht (Professor, Program Director of Regional Anaesthesia & Clinical Research)","doi":"10.1016/j.bpa.2023.02.002","DOIUrl":"10.1016/j.bpa.2023.02.002","url":null,"abstract":"<div><p>Intrathecal opioids have been used for several decades in different clinical settings. They are easy to administer and provide many benefits in clinical practice, such as better quality of spinal anaesthesia, prolonged postoperative analgesia, decreased postoperative analgesic requirements and early mobilisation. Several lipophilic and hydrophilic opioids are available for intrathecal administration, either in combination with general anaesthesia or as adjuncts to local anaesthetics. Adverse effects after intrathecal lipophilic opioids administration are predominantly short-lived and benign. In contrast, intrathecal hydrophilic opioids may have potentially serious adverse effects, the most feared of which is respiratory depression. In this review, we will focus on the contemporary evidence regarding intrathecal hydrophilic opioids and present their adverse effects and how to manage them.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 199-207"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of the combined spinal-epidural technique in obstetrics and surgery","authors":"Eva Roofthooft MD ,&nbsp;Narinder Rawal Professor, MD, PhD, FRCA (Hon), EDRA ,&nbsp;Marc Van de Velde Professor, MD, PhD, EDRA","doi":"10.1016/j.bpa.2023.04.004","DOIUrl":"10.1016/j.bpa.2023.04.004","url":null,"abstract":"<div><p><span><span>Epidural and spinal blocks are well-accepted neuraxial techniques but both have several disadvantages. Combined spinal-epidural (CSE) can combine the best features of both techniques and reduce or eliminate these disadvantages. It provides the rapidity, density, and reliability of subarachnoid block with the flexibility of catheter epidural technique to extend the duration of anesthesia/analgesia (and to improve spinal block). It is an excellent technique for determining minimum intrathecal </span>drug doses. Although most commonly employed in </span>obstetric<span><span> practice, CSE is also used in a wide variety of non-obstetric surgical procedures including orthopedic, vascular, gynecological, urological, and general surgical procedures. The needle-through-needle technique remains the most commonly used method to perform CSE. Several technical variations including Sequential CSE and Epidural Volume Extention (EVE) are commonly used particularly in obstetric and high-risk patients such as those with cardiac disease where a slower onset of sympathetic block is desirable. The risks of complications such as epidural </span>catheter migration<span> through the dural hole, neurological complications, and subarachnoid spread of epidurally administered drugs are possible but have not been a clinically relevant problem in the 40+ years of their existence.</span></span></p><p>In obstetrics, CSE is used for labor pain because it produces rapid-onset analgesia with reduced local anesthetic<span><span> consumption and less motor block. The epidural catheter placed as part of a CSE is more reliable than a catheter placed as part of a conventional epidural. Less breakthrough pain throughout labor is noted and fewer catheters require replacing. Side effects of CSE include greater potential for hypotension and more </span>fetal heart rate<span> abnormalities. CSE is also used for cesarean delivery. The main purpose is to decrease the spinal dose so that spinal-induced hypotension can be reduced. However, reducing the spinal dose requires an epidural catheter to avoid intra-operative pain when surgery is prolonged.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 189-198"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathecal drug delivery in the management of chronic pain","authors":"Jan Van Zundert MD, PhD, FIPP (Professor) ,&nbsp;Richard Rauck MD, FIPP (Associate Professor, Wake Forest School of Medicine)","doi":"10.1016/j.bpa.2023.02.003","DOIUrl":"10.1016/j.bpa.2023.02.003","url":null,"abstract":"<div><p>Targeted intrathecal drug<span> delivery (TIDD) has the objective of bringing the drug(s) close to the receptors influencing pain modulation, and thus reducing the dose and the side effects. Intrathecal drug delivery knew its real start with the development of permanent implantation of intrathecal and epidural catheters, combined with internal or external ports, reservoirs, and programmable pumps.</span></p><p><span>TIDD is a valuable treatment for patients with cancer suffering refractory pain. Patients suffering noncancer-related pain should only be considered for TIDD when all other options have been tested, including </span>spinal cord stimulation.</p><p>Only two drugs are approved by the US Food and Drug Administration for TIDD administration for chronic pain: morphine and ziconotide<span> as monotherapy. In pain management, off-label use of medication and combination therapy is often reported.</span></p><p>The specific action of the intrathecal drugs, the efficacy and safety, is described, as well as the modalities for trialing intrathecal drug delivery and the implantation methods.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 157-169"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuraxial drug delivery in pain management: An overview of past, present, and future","authors":"Tony L. Yaksh (Professor),&nbsp;Gilson Goncalves dos Santos (Asst. Project Scientist),&nbsp;Julia Borges Paes Lemes (Postdoctoral Scholar),&nbsp;Kaue Malange (Postdoctoral Scholar)","doi":"10.1016/j.bpa.2023.04.003","DOIUrl":"10.1016/j.bpa.2023.04.003","url":null,"abstract":"<div><p>Activation of neuraxial nociceptive linkages leads to a high level of encoding of the message that is transmitted to the brain and that can initiate a pain state with its attendant emotive covariates. As we review here, the encoding of this message is subject to a profound regulation by pharmacological targeting of dorsal root ganglion and dorsal horn systems. Though first shown with the robust and selective modulation by spinal opiates, subsequent work has revealed the pharmacological and biological complexity of these neuraxial systems and points to several regulatory targets. Novel therapeutic delivery platforms, such as viral transfection, antisense and targeted neurotoxins, point to disease-modifying approaches that can selectively address the acute and chronic pain phenotype. Further developments are called for in delivery devices to enhance local distribution and to minimize concentration gradients, as frequently occurs with the poorly mixed intrathecal space. The field has advanced remarkably since the mid-1970s, but these advances must always address the issues of safety and tolerability of neuraxial therapy.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 243-265"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9667724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current indications for spinal anesthesia-a narrative review","authors":"Balavenkatasubramanian (Senior Consultant),&nbsp;Senthilkumar (Consultant),&nbsp;Vinoth Kumar (Consultant)","doi":"10.1016/j.bpa.2023.04.001","DOIUrl":"10.1016/j.bpa.2023.04.001","url":null,"abstract":"<div><p>Spinal anesthesia<span> is a commonly performed regional anesthesia technique by most anesthesiologists worldwide. This technique is learned early during training and is relatively easy to master. Despite being an old technique, spinal anesthesia has evolved and developed in various aspects. This review attempts to highlight the current indications of this technique. Understanding the finer aspects and knowledge gaps will help postgraduates and practicing anesthesiologists in designing patient-specific techniques and interventions.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 89-99"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9652353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal technique – Still going strong after 125 years!","authors":"Narinder Rawal (Professor)","doi":"10.1016/j.bpa.2023.04.006","DOIUrl":"10.1016/j.bpa.2023.04.006","url":null,"abstract":"","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 87-88"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9646056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postdural puncture headache: Revisited","authors":"Alexandra M.J.V. Schyns-van den Berg (Senior Consultant) ,&nbsp;Anil Gupta (Associate Professor, Senior Consultant)","doi":"10.1016/j.bpa.2023.02.006","DOIUrl":"10.1016/j.bpa.2023.02.006","url":null,"abstract":"<div><p><span>Postdural puncture headache<span><span> (PDPH) may develop after an unintended (accidental) dural puncture, after deliberate dural puncture for spinal anaesthesia or during diagnostic dural punctures performed by other medical specialties. PDPH may sometimes be predictable (patient characteristics, inexperienced operator or co-morbidities), is almost never immediately evident during the procedure, and sometimes presents late, </span>after discharge. Specifically, PDPH severely restricts </span></span>activities of daily living<span>, patients may be bedridden for several days and mothers may have difficulty in breastfeeding. Although an epidural blood patch<span> (EBP) remains the management technique with greatest immediate success, most headaches resolve over time but may cause mild-severe disability. Failure of EBP after the first attempt is not uncommon, and major complications may occur but are rare. In the current review of the literature, we discuss the pathophysiology, diagnosis, prevention and management of PDPH following accidental or intended dural puncture, and present possible therapeutic options for the future.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 171-187"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9646058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal anaesthesia in obstetrics","authors":"Vincent Pirenne (Trainee in Anesthesia),&nbsp;Geertrui Dewinter (Professor in Anesthesia),&nbsp;Marc Van de Velde (Professor in Anesthesia)","doi":"10.1016/j.bpa.2023.03.006","DOIUrl":"10.1016/j.bpa.2023.03.006","url":null,"abstract":"<div><p>This article provides a comprehensive review of the technique, drugs<span><span> of choice, and potential side effects and complications associated with the drugs used and the single-shot spinal anaesthesia<span> (SSS) technique for caesarean delivery<span>. Although neuraxial analgesia and anaesthesia are generally considered safe, all interventions come with potential adverse effects. As such, the practice of obstetric anaesthesia has evolved to minimize such risks. This review highlights the safety and efficacy of SSS for caesarean delivery while also discussing potential complications such as hypotension, </span></span></span>postdural puncture headache<span>, and nerve injury. In addition, drug selection and dosages are examined as well, emphasizing the importance of individualized treatment plans and close monitoring for optimal outcomes.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 2","pages":"Pages 101-108"},"PeriodicalIF":4.8,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9658457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction and history of anaesthesia-induced neurotoxicity and overview of animal models","authors":"Tom Bleeser MD ,&nbsp;Talia Rose Hubble MD ,&nbsp;Marc Van de Velde (Professor, MD) ,&nbsp;Jan Deprest (Professor, MD) ,&nbsp;Steffen Rex (Professor, MD) ,&nbsp;Sarah Devroe (Professor, MD)","doi":"10.1016/j.bpa.2022.11.003","DOIUrl":"10.1016/j.bpa.2022.11.003","url":null,"abstract":"<div><p><span>Brain development is initiated at around 3 weeks of gestation. The peak velocity of brain weight gain occurs around birth, with the neural circuitry subsequently being refined until at least 20 years of age. Antenatal and postnatal </span>general anaesthesia<span><span> suppresses neuronal firing during this critical period and may therefore impair brain development, referred to as “anaesthesia-induced neurotoxicity”. Whilst up to 1% of children are exposed to general anaesthesia antenatally (e.g., as an innocent bystander to maternal laparoscopic appendectomy), 15% of children under 3 years of age undergo general anaesthesia postnatally (e.g., otorhinolaryngologic surgery). In this article, the history of preclinical and clinical research<span> in anaesthesia-induced neurotoxicity will be reviewed, starting from the pioneering preclinical study in 1999 until the most recent </span></span>systematic reviews. The mechanisms of anaesthesia-induced neurotoxicity are introduced. Finally, an overview of the methods used in preclinical studies will be provided, with a comparison of the different animal models that have been employed to investigate this phenomenon.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"37 1","pages":"Pages 3-15"},"PeriodicalIF":4.8,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9614014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}