oliviawinstead

[oliviawinstead]

A Conceptual Model of Trigeminal Neuralgia Network and tDCS Pain Reduction Effect

A Conceptual Model of Trigeminal Neuralgia Network and tDCS Pain Reduction Effect by Farzad Towhidkhah in Developments in Anaesthetics & Pain Management_Crimson Publishers: Journal of Anaesthetics

Trigeminal Neuralgia (TN) is an attacking, abrupt and electric-shock headache in the realm of one or two branches of trigeminal nerves. It is one of the most severe neuropathic pains ever known. By considering main known regions of the brain involved in TN, we made a conceptual model named TN pain neuro matrix. Then we took an external stimulation into account and assayed the different possible approaches about how it may be concluded to pain relief.

Keywords: Conceptual modeling; Pain management; Pain network; Trigeminal neuralgia; Transcranial direct current stimulation

Abbreviations: TN: Trigeminal Neuralgia; tDCS: Transcranial Direct Current Stimulation; S1: Primary Somatosensory Cortex; S2: Secondary Somatosensory Cortex; IC: Insula Cortex; ACC: Anterior Cingulate Cortex; PCC: Posterior Cingulate Cortex; PF: Prefrontal Cortex; PAG: Periaqueductal Gray; M1: Primary Motor Cortex; SMA: Supplementary Motor Area; PB: Parabrachial Nucleus; ISVT: Interstitial Nucleus of the Spinal Trigeminal Tract; DRG: Dorsal Root Ganglion; VPL: Ventral Posterolateral Nucleus; VPM: Ventral Posteromedial Nucleus; RF: Reticular Formation; SCA: Superior Cerebellar Artery; VAS: Visual Analogue Scale; nBR: Nociceptive Blink Reflex; PREP: Pain-Related Evoked Potentials; MRI: Magnetic Resonance Imaging; H-MRS: Proton Magnetic Resonance Spectroscopy; TG: Trigeminal Ganglion; CeA: Central Nucleus of Amygdala; PSN: Principle Sensory Nucleus; STN: Spinal Trigeminal Nucleus.

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[oliviawinstead]

Emerging Role of Bedside Ocular Ultrasound in Emergency Department and Intensive Care Unit_Crimson Publishers

Emerging Role of Bedside Ocular Ultrasound in Emergency Department and Intensive Care Unit by  Surjya Prasad Upadhyay in Developments in Anaesthetics & Pain Management_Crimson Publishers: Journal of Anaesthetics

Abstract

Ultrasonography (US) is being increasingly used outside the radiology suites into various areas like operative room (OR), intensive care (ICU) and emergency department (ED) both as diagnostic tool as well to guide interventions. The popularity and application of US for vascular catheterization, thoracic and abdominal assessment in ED and ICU has increased dramatically over the last decade. The orbital US is one the simple, quick and potential imaging tool to assess not only ocular pathology, but also act as window for intracranial pathology which provide bedside, real time information. Ultrasound has become integral part of ED and ICU and can be applied as bed side point of care in variety of traumatic or non-traumatic ocular condition. This review provides updated information on the emerging application of orbital US in ED and ICU for various ocular and intracranial pathology.

Keywords: Ocular ultrasonography; Ocular trauma; Retinal detachment; Intracranial pressure

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[oliviawinstead]

Multi-Modal Neuro-Monitoring and Anesthesia during Neurosurgery in a Child with Wolf-Parkinson-White Syndrome: A Case Report_Crimson Publishers

Multi-Modal Neuro-Monitoring and Anesthesia during Neurosurgery in a Child with Wolf-Parkinson-White Syndrome: A Case Report by Chulananda Goonasekera in  Developments in Anaesthetics & Pain Management_Crimson Publishers: Journal of Anaesthetics

Abstract

Wolff Parkinson White (WPW) syndrome associates with life-threatening tachy-arrhythmias. We report anesthetic management of a child with WPW syndrome requiring neurosurgery to resect 3 tumourdeposits (in cerebral hemisphere, cerebellum and spinal cord) under the guidance of intraoperative neuro-physiological monitoring (IONM). Our purpose of this case report is to elucidate the anesthetic limitations in facilitating multiple modes of neuro-monitoring whilst minimizing the risk of triggering an arrhythmia in a child with WPW syndrome. We conclude that multiple modes of IONM is safely possible with a tailor made, proportionately adjusted, inhalational and intravenous general anesthetic with particular attention to the cumulative doses of intravenous agents used.

Keywords: Pediatric, Anesthesia, Neuro-navigation, WPW syndrome

Abbreviations: WPW: Wolff Parkinson White Syndrome; IONM: Intra-Operative Neuro-Physiological; EEG : Electro Encephalo Graphy; MEP : Motor Evoked Potential; SSEPs : Somatosensory Evoked Potentials; FR-EMG : Continuous Free Run Electromyo Graphy; CoMEPs : Cortico-bulbar Motor Evoked Potentials; GCS : Glasgow Coma Score; PSVT : Paroxysmal Supra Ventricular Tachycardia; AF : Atrial Fibrillation; TIVA : Total Intra-Venous Anesthesia.

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[oliviawinstead]

Sphenopalatine Ganglion Block: An Underutilized Tool in Pain Management_Crimson Publishers

Sphenopalatine Ganglion Block: An Underutilized Tool in Pain Management by Barry J Kraynack in  Developments in Anaesthetics & Pain Management_Crimson Publishers: Journal of Anaesthetics

Abstract The sphenopalatine ganglion (SPG) block has been utilized to treat a wide variety of pain disorders. Postganglionic parasympathetic, sympathetic neurons, and the somatic sensory afferents can all be blocked by an SPG block. We examine the SPG anatomy, the techniques of blockade and the vast spectrum of conditions and indications for SPG block for pain relief. SPG block is an easy, safe and cost-effective method of management of acute, chronic and breakthrough pain which provides immediate relief and minimal side effects. It can be performed in a hospital or surgery center, clinic, office, ER department or at home. It is presently an underutilized and overlooked tool in pain therapy that should be more widely used.

Introduction Anatomy Because the sphenopalatine ganglion (SPG) has diffuse and extensive anatomical connections within the trigemino-autonomic (parasympathetic) reflex, it is of great interest to clinicians who treat pain conditions [1]. The SPG is a large extra cranial parasympathetic ganglion with multiple neural roots, including autonomic, sensory, and motor [2,3]. The SPG is a five-mm triangular shaped parasympathetic ganglion, located superficially and anterior to the pterygoid canal in the pterygopalatine fossa at the level of the middle nasal turbinate bilaterally. It is also known as the pterygopalatine, nasal or Meckel's ganglion [4]. It is enclosed in mucous membrane and a thin layer (1 to 1.5mm) of connective tissue. It is denoted as parasympathetic because preganglionic parasympathetic fibers synapse within the SPG. It is the largest peripheral parasympathetic ganglion with manifold connections to general sensory fibers and the internal carotid plexus [5-7].

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[oliviawinstead]

Addiction and Compliance_Crimson Publishers

Addiction and Compliance by Keith A Raymond in Developments in Anaesthetics & Pain Management_Crimson Publishers: Journal of Anaesthetics

At the end of my clinical hours here in Europe, I met with some patients to discuss current events. They were completely unaware, and even surprised by, the opiate problem in the United States. It certainly is not a problem here in Austria, much less the rest of Europe. In Portugal, where illicit drugs were decriminalized in 2001, the drug overdose death rate was 3 per million in 2015. In the UK during the same year, it was 45 opiate related deaths per million [1]. For 2015, the NIH reported about 100 deaths per million in the US from opioid overdose. This is one overdose death per 5914 opiate prescriptions written in that year. The numbers in the US are worth reflection and appear suspect [2]. This suggests most of these deaths are due to diversion not prescription. To put these numbers in perspective, the number of people that died with Alzheimer’s disease in 2015 was 93,500 vs. opioid related deaths in the same year of 35,000 in the USA [3].

The UN World Drug Report of 2016 considered EU opiate consumption by country, using annual questionnaires. All countries showed decreases of use during the period from 1999 - 2014 except one, Italy. Heroin use in Italy doubled, from 0.4 percent of the population to 0.8 percent for ages 15 to 64. In 2015, 1.4 percent of male Italians, and 0.6 percent female Italians had injected drugs (refugees are included) (Figure 1).

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[oliviawinstead]

Postoperative Pain Management_Crimson Publishers

Postoperative Pain Management by Thamilselvam P in Developments in Anaesthetics & Pain Management_Crimson Publishers: Journal of Anaesthetics

Pain is an unpleasant and sometime unbearable experience which can produce changes in all the systems of the body. Postoperative pain is both distressing and detrimental for the patient. The management of postoperative pain involves assessment of the pain in terms of intensity at rest and activity associated pain, treatment by pharmacological and non pharmacological means as well as monitoring induced side-effects. The pain would cause the patient to remain in bed and immobile, thus it would lead to DVT, pulmonary atelectasis, muscle wasting, bedsores, urinary retention and some psychological disorders. There are much analgesia which includes opioids and non-opioids. These can be delivered through many routes, neuraxial use of local anaesthetics, nerve blocks, and techniques such as patient controlled analgesia and pre-emptive analgesia have greatly improved the efficacy of pain-control while minimizing the side-effects of any one type. We focus the area of causes of pain and its management.

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