15 Dec 09

Are epidurals worthwhile in vascular surgery?

Posted in Anesthesia, Pain medicine at 5:44 by Laci

By B Veering

Curr Op Anaesthes 2008;21:616-618

Patients undergoing major vascular surgery are at increased risk for postoperative complications due to the high incidence of comorbidities in this population. Epidural anaesthesia provides potential benefits but its effect on morbidity and mortality is unclear.

Recent findings
Existing studies fail to demonstrate improved clinical outcome and reduced mortality for epidural anaesthesia or combined epidural/general techniques compared with general anaesthesia. Postoperative epidural analgesia provides better pain relief and reduces the duration of postoperative mechanical ventilation.

Summary
Optimization of perioperative care rather than the anaesthetic technique may have potential benefit in improving postoperative outcome.

31 Jan 06

Recent advances in the treatment of headaches

Posted in General, Pain medicine at 12:56 by Laci

By S Evers, A Frese

Curr Op Anaest 2005, 18:563-568

Purpose of review
In past years, important advances have been made in the treatment of idiopathic headache disorders. New controlled trials have been published for the acute and the prophylactic drug and non-drug therapies. Furthermore, new headache entities have been described by the International Headache Society for which treatment recommendations can be given.

Recent findings
Triptans and non-steroidal anti-inflammatory drugs are still the drugs of first choice for the treatment of migraine attacks. Recent studies show that early treatment is clearly effective in migraine and that differential therapy with triptans can be helpful. New drugs with new mechanisms are being developed such as a calcitonin gene-related peptide antagonist. For the prophylaxis of migraine, topiramate has been introduced as an effective new drug. Botulinum toxin did not show convincing evidence of efficacy in migraine and tension-type headache. For migraine and cluster headache, surgical procedures such as the closure of the patent foramen ovale (migraine) and neurostimulation of the hypothalamus (cluster headache) are also under evaluation. A group of miscellaneous headaches (group 4 of the International Headache Society classification) is also described, for which treatment recommendations, in particular indomethacin in most cases, can now be given although no placebo-controlled trials have been performed.

Summary
Recent advances in headache treatment comprise growing evidence for an appropriate drug administration and for differential drug therapy rather than the development of new drugs or procedures. Surgical and other non-drug treatment procedures are under discussion and might be an additional tool for headache treatment in future years.

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