Anesthesiology
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Despite the frequent use of ropivacaine and bupivacaine, there is limited guidance on redosing of these medications following an initial bolus. Intermittent redosing is a clinical practice in the setting of nerve catheters, often utilizing large doses. Comparatively, theoretical elimination rates are available from pharmacokinetic studies, providing estimates on total body content of these drugs. We hypothesized that published redosing of bupivacaine and ropivacaine in clinical literature comported with safe elimination of the drugs based on pharmacokinetic studies. ⋯ Clinically reported redosing of bupivacaine and ropivacaine in the published literature reflect the slowest pharmacokinetic elimination based on human studies. The combined data without evidence of toxicity permit us to make practical recommendations about safe redosing of these agents.
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Improving healthcare professional well-being and reducing burnout requires improving work ecosystems and cultures. Current well-being metrics focus on distal outcomes within individuals (e.g., professional fulfillment or burnout). In this study, we developed and evaluated the performance of an inventory measuring perceptions of modifiable workplace dimensions-termed influencers-that shape healthcare professionals' well-being. ⋯ WISH fills a key gap in healthcare professional well-being improvement science by assessing causal factors of well-being and burnout, rather than the conditions themselves. Here, we established initial validity of this unique inventory and further reinforce the relevance of system-level and cultural factors in influencing healthcare professionals' well-being. WISH is well suited to assist healthcare professional well-being improvement efforts driven by system-improvement mindsets.
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Prescription rates for buprenorphine in opioid use disorder are increasing, and recent guidelines recommend its continuation during and after surgery; however, evidence from clinical outcome studies is limited. The authors tested the hypotheses (1) that perioperative continuation of buprenorphine does not result in higher pain scores and (2) that this approach does not result in higher supplemental postoperative opioid requirements. ⋯ Continuation of buprenorphine is not associated with higher average pain scores or postoperative opioid requirements, supporting recently published guidelines.
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Emerging evidence indicates that cyclic nucleotide phosphodiesterases exert distinct functions in pain processing and that targeting phosphodiesterases might be a novel strategy for pain relief. This study hypothesized that the phosphodiesterase isoform phosphodiesterase 10A (PDE10A) might be a target for analgesic therapy. ⋯ Collectively, the data support the idea that PDE10A is a suitable target for the development of efficacious analgesic drugs.